{"doi":"10.1111/ppe.13020","title":"History of multifetal gestation and long‐term maternal mortality","abstract":"BACKGROUND: Multifetal gestation could be associated with higher long-term maternal mortality because it increases the risk of pregnancy complications such as preeclampsia and preterm birth, which are in turn linked to postpartum cardiovascular risk. OBJECTIVES: We examined whether spontaneously conceived multifetal versus singleton gestation was associated with long-term maternal mortality in a racially diverse U.S. METHODS: We ascertained vital status as of 2016 via linkage to the National Death Index and Social Security Death Master File of 44,174 mothers from the Collaborative Perinatal Project (CPP; 1959-1966). Cox proportional hazards models with maternal age as the time scale assessed associations between history of spontaneous multifetal gestation (in the last CPP observed pregnancy or prior pregnancy) and all-cause and cardiovascular mortality, adjusted for demographics, smoking status, and preexisting medical conditions. We calculated hazard ratios (HR) for all-cause and cause-specific mortality over the study period and until age 50, 60, and 70 years (premature mortality). RESULTS: Of eligible participants, 1672 (3.8%) had a history of multifetal gestation. Participants with versus without a history of multifetal gestation were older, more likely to have a preexisting condition, and more likely to smoke. By 2016, 51% of participants with and 38% of participants without a history of multifetal gestation had died (unadjusted all-cause HR 1.14, 95% confidence interval [CI] 1.07, 1.23). After adjustment for smoking and preexisting conditions, a history of multifetal gestation was not associated with all-cause (adjusted HR 1.00, 95% CI 0.93, 1.08) or cardiovascular mortality (adjusted HR 0.99, 95% CI 0.87, 1.11) over the study period. However, history of multifetal gestation was associated with an 11% lower risk of premature all-cause mortality (adjusted HR 0.89, 95% CI 0.82, 0.96). CONCLUSIONS: In a cohort with over 50 years of follow-up, history of multifetal gestation was not associated with all-cause mortality, but may be associated with a lower risk of premature mortality.","journal":"Paediatric and Perinatal Epidemiology","year":2023,"id":363144,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9516,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":256216,"name":"Rajeshwari Sundaram","orcid":"0000-0002-6918-5002","position":1,"is_corresponding":false},{"id":1026963,"name":"Yan Qiao","orcid":"0000-0002-5005-5996","position":2,"is_corresponding":false},{"id":524925,"name":"Jessica L. Gleason","orcid":"0000-0001-9877-7931","position":3,"is_corresponding":false},{"id":256223,"name":"Edwina Yeung","orcid":"0000-0002-3851-2613","position":4,"is_corresponding":false},{"id":308445,"name":"Stefanie N. Hinkle","orcid":"0000-0003-4312-708X","position":5,"is_corresponding":false},{"id":291975,"name":"Pauline Mendola","orcid":"0000-0001-5330-2844","position":6,"is_corresponding":false},{"id":308451,"name":"James L. Mills","orcid":"0000-0003-4496-332X","position":7,"is_corresponding":false},{"id":1051110,"name":"Sonia M. Grandi","orcid":"0000-0002-8576-7854","position":8,"is_corresponding":false},{"id":311701,"name":"Sunni L. Mumford","orcid":"0000-0003-0133-3176","position":9,"is_corresponding":false},{"id":311707,"name":"Enrique F. Schisterman","orcid":"0000-0003-3757-641X","position":10,"is_corresponding":false},{"id":291978,"name":"Cuilin Zhang","orcid":"0000-0002-8014-2708","position":11,"is_corresponding":false},{"id":271560,"name":"Katherine L. Grantz","orcid":"0000-0003-0276-8534","position":12,"is_corresponding":false},{"id":476818,"name":"Susanna D. Mitro","orcid":"0000-0003-3202-1941","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-19T01:14:28.054440Z","pmid":"37969031","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}