Elser Holly, Mumford Sunni L, Grantz Katherine L, Pollack Anna Z, Mendola Pauline, Mills James L, Yeung Edwina, Zhang Cuilin, Schisterman Enrique F, Hinkle Stefanie N
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Paediatr Perinat Epidemiol. 2025 Mar;39(3):244-253. doi: 10.1111/ppe.13166. Epub 2025 Feb 25.
Postpartum haemorrhage (PPH) is associated with significant short-term morbidity and mortality. Whether PPH confers long-term all-cause mortality risk is unknown.
To examine the risk of long-term mortality associated with PPH.
The Collaborative Perinatal Project (CPP) Mortality Linkage Study is a prospective cohort study of pregnant persons (1959-1966) linked with vital status from the National Death Index and Social Security Death Master File for vital status through 2016. Postpartum haemorrhage was defined based on documentation of haemorrhage within or after 24 hours of delivery in obstetric records. We used Cox regression to examine associations of PPH with long-term all-cause mortality. All models adjusted for delivery characteristics, comorbid medical diagnoses, and sociodemographic characteristics. We further explored heterogeneity in all-cause mortality by sociodemographic characteristics.
Of the 43,583 participants with a singleton pregnancy, 1532 (3.5%) experienced PPH, and 17,165 (39.4%) had died by 2016. The median follow-up time was 52 years (interquartile range 45-54). PPH was associated with increased all-cause mortality risk in unadjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.04, 1.21) but not in fully adjusted models (HR 1.02, 95% CI 0.94, 1.11). While HRs varied across sociodemographic subgroups, results were imprecise. We found no evidence of increased cause-specific mortality risk associated with PPH.
Although PPH is associated with short-term morbidity and mortality, our results are generally reassuring against the increased risk of long-term mortality associated with PPH.
产后出血（PPH）与显著的短期发病率和死亡率相关。产后出血是否会带来长期全因死亡风险尚不清楚。
研究与产后出血相关的长期死亡风险。
围产期协作项目（CPP）死亡率关联研究是一项对孕妇（1959 - 1966年）的前瞻性队列研究，通过国家死亡指数和社会保障死亡主文件将其与截至2016年的生命状态相联系。产后出血根据产科记录中分娩后24小时内或分娩后出血的记录来定义。我们使用Cox回归来研究产后出血与长期全因死亡率的关联。所有模型均对分娩特征、合并的医学诊断和社会人口学特征进行了调整。我们进一步按社会人口学特征探讨了全因死亡率的异质性。
在43,583名单胎妊娠参与者中，1532人（3.5%）经历了产后出血，到2016年有17,165人（39.4%）死亡。中位随访时间为52年（四分位间距45 - 54年）。在未调整的模型中，产后出血与全因死亡风险增加相关（风险比[HR]为1.12，95%置信区间[CI]为1.04, 1.21），但在完全调整的模型中则不然（HR为1.02，95% CI为0.94, 1.11）。虽然风险比在不同社会人口学子组中有所不同，但结果并不精确。我们没有发现与产后出血相关的特定病因死亡风险增加的证据。
尽管产后出血与短期发病率和死亡率相关，但我们的结果总体上让人放心，即产后出血不会增加长期死亡风险。
