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
