COLLABORATIVE PERINATAL PROJECT (CPP) MORTALITY

怀孕是一种常见的事件，会对母亲的生理造成重大压力，代谢、血流动力学和激素水平的实质性变化可能会暴露出女性潜在的疾病风险。例如，怀孕的血管需求可能揭示出日后心血管疾病的潜在脆弱性。先前的研究表明，先兆子痫会增加心血管疾病的死亡率，特别是对早产的妇女(Irgens等人。2001年)，我们已经表明，血压的任何升高都会增加以后患慢性疾病(肾脏疾病、糖尿病、高血压)的风险以及心肌梗塞的死亡率(Mannisto等人)。2013)。同样，妊娠期糖耐量低的妇女很可能由于潜在的β细胞功能障碍而患上II型糖尿病(Bellamy et a！2009年)。大多数研究使用行政数据而不是临床数据来获取怀孕信息，这在完整的临床测量(例如血压)而不是诊断代码的完整性和可用性方面是有限的。对芬兰北部出生队列进行了近40年的随访，由于有丰富的临床数据，能够发现新的关联(Mannisto等人)。2013)。这些先前的研究使用欧洲国家的国家联系的健康记录是可行的(Irgens等人。2001年；罗尔夫等人。2012年)。尽管美国国家死亡指数(NDI)提供了有价值的死因信息，但这种联系在美国是不可能的，因为缺乏可能与NDI有关的详细怀孕记录。这带来了一个重大的数据鸿沟。为了弥补这一差距，我们建议将参与合作围产期项目(CPP)的女性与国家死亡指数(NDI)联系起来，国家死亡指数(NDI)保留了1979-2012年间的死因记录。CPP是一项在1959-1965年间对48,197名女性(Niswander和Gordon 1972)进行的多地点前瞻性队列研究。CPP是美国进行的最大规模的预期怀孕研究，提供了关于孕妇健康状况的详细信息。确定CPP研究参与者的生命状态将创造一个宝贵的资源，可以回答许多重要的研究问题，以进一步了解孕妇的健康状况和未来全原因和特定原因死亡的风险

Pregnancy is a common event that imposes significant stresses on maternal physiology, with substantive changes in metabolism, hemodynamics, and hormone levels that can expose underlying disease risks for women. For example, the vascular demands of pregnancy can reveal underlying vulnerability for later cardiovascular disease. Previous studies have shown that preeclampsia increases mortality from cardiovascular disease, particularly for women who have preterm deliveries (Irgens et al. 2001) and we have shown that any elevation in blood pressure increases risk for later chronic disease (kidney disease, diabetes, hypertension) as well as mortality from myocardial infarcts (Mannisto et al. 2013). Similarly, women with poor glucose tolerance during pregnancy are likely to develop type II diabetes due to underlying beta cell dysfunction (Bellamy et a!. 2009). Rather than clinical data, most studies have used administrative data to capture pregnancy information, which is limited in completeness and availability of full clinical measures (e.g. blood pressure) rather than diagnostic codes. The Northern Finnish Birth Cohort follow-up of nearly 40 years, was able to find novel associations because of the rich clinical data available (Mannisto et al. 2013). These previous studies have been feasible using nationally linked health records in European nations (Irgens et al. 2001;Rolv et al. 2012). Such linkages have not been possible in the US despite the National Death Index (NDI), which provides valuable cause of death information, because detailed pregnancy records, which could be linked to the NDI, were lacking. This presents a major data gap. To address this gap, we propose to link women who participated in the Collaborative Perinatal Project (CPP), a multi-site U.S. prospective cohort study from 1959-1965 of 48,197 women (Niswander and Gordon 1972), to the National Death Index (NDI), which maintains cause of death records fi¿om 1979-2012. The CPP is the largest prospective pregnancy study undertaken in the US and provides detailed information on gravid health conditions. Ascertaining the vital status of CPP study participants will create a valuable resource which can answer many important research questions to further the understanding of gravid health conditions and future risk of all-cause and cause-specific mortality