aObjective The aim of this study was to investigate whether the risk of developing ischaemic heart disease (IHD) later in life increases with severity and recurrence of gestational hypertensive disease. Design Cross-sectional population-based study.Setting Sweden.Population Women (403,550) giving birth to their first child in Sweden, 1973Sweden, -1982. Of this cohort, 207,054 women who also gave birth to a second child during the same period were analysed separately. Methods All women were followed up for 15 years, starting 4 -14 years after the index pregnancy. Women who suffered from hypertensive disease during pregnancy were compared with women with normal pregnancies with regard to hospitalisation for, or death from, IHD during the follow up period. Main outcome measures Fatal or non-fatal IHD.Results The adjusted incidence rate ratio (IRR) for later development of IHD was 1.6 (95% CI 1.3-2.0) when the first pregnancy was complicated by gestational hypertension without proteinuria, 1.9 (95% CI 1.6 -2.2) for mild pre-eclampsia and 2.8 (95% CI 2.2 -3.7) for severe pre-eclampsia. Women with gestational hypertension in their first pregnancy but not in their second had an adjusted IRR of 1.9 (95% CI 1.5-2.4) for development of IHD. Women with hypertensive disease in both pregnancies had an IRR of 2.8 (95% CI 2.0 -3.9) compared with women with two normal pregnancies. Conclusion Severe hypertensive disease in pregnancy has a stronger association with later development of IHD than has mild hypertensive disease. Recurrent hypertensive disease is more strongly associated with IHD than is non-recurrent disease.

Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling. Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007. Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007. Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade Ͼ2, retinopathy of prematurity stage Ͼ2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival. Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% (95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% (95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth (OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity. Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks.

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Objective The first aim of this study was to investigate the risk of pre-eclampsia, both mild and severe, in women born small for gestational age (SGA). The second aim was to investigate whether the risk is modified by pre-eclampsia in the previous generation.Design Population-based cohort study.Setting Sweden. Methods The pregnancies that the women were born out of were analysed with regard to presence of pre-eclampsia, while their own pregnancies were analysed regarding age at delivery, smoking, body mass index and incidence of mild or severe pre-eclampsia. Multiple logistic regression analysis was used. In a first step, we adjusted for maternal characteristics, and in a second step, for pre-eclampsia in the previous generation.Main outcome measures Odds ratio for mild and severe preeclampsia.Results In women born SGA, the adjusted odds ratio (first step) for mild pre-eclampsia was 1.19 (95% CI 1.03-1.38), while for severe pre-eclampsia it was 1.69 (95% CI 1.40-2.02) compared with those not born SGA. After the second-step adjustment, the odds ratio for mild pre-eclampsia was 1.16 (95% CI 1.00-1.35) and for severe pre-eclampsia was 1.62 (95% CI 1.35-1.95). No statistically significant effect modification from pre-eclampsia in the previous generation was shown.Conclusions Women born SGA suffer a markedly increased risk of severe pre-eclampsia. Exposure to pre-eclampsia during a woman's own fetal development significantly increases her risk of pre-eclampsia but does not modify the SGA effect.

Mothers with chronic hypertension have an increased risk of perinatal mortality of their male offspring.