The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

3273.0: Monday, November 17, 2003 - 3:15 PM

Abstract #55042

Pregnancy-associated mortality compared to mortality among non-pregnant women

Mika Gissler, Dr Phil, STAKES Information Division, STAKES National Research and Development Centre for Welfare and Health, P.O.BOX 220, Lintulahdenkuja 4, Helsinki, 00531, Finland, +358-40-5033805,, Cynthia Berg, MD, Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, Marie-Hélène Bouvier-Colle, INSERM (France) U 149- Epidemiological research unit on perinatal and women health, 123, bd Port Royal, PARIS (France), 75014, France, and Pierre Buekens, MD, PhD, Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, CB 7400 Rosenau Hall, Chapel Hill, NC 27599-7400.

Reliable information on pregnancy-associated deaths is rare, especially deaths occurring after pregnancies not ending in a birth. To compare pregnancy-associated mortality to mortality among non-pregnant women, information on all deaths of women aged 15-49 in Finland (N=15,823 in 1987-2000) was obtained from the Cause-of-Death Register and linked to the Medical Birth Register (N=865,988 live and stillbirths), the Register on Induced Abortions (N=156,789 induced abortions) and the Hospital Discharge Register (N=118,490 spontaneous abortions and ectopic pregnancies).We identified 419 pregnancy-associated deaths. The age-adjusted pregnancy-associated mortality was 36.7 per 100,000 pregnancies, significantly lower than among non-pregnant women (RR=0.64). The mortality was lower after a birth (28.2/100,000) than after a spontaneous or induced abortion (70.8/100,000). Pregnancy-associated mortality from natural causes, cancers, and diseases of the circulatory system was lower than mortality among non-pregnant women, except for an increased post-delivery mortality from cerebrovascular diseases among women aged 15-24 (RR=4.08). Overall pregnancy-associated mortality from violent causes was lower than mortality from violent causes among non-pregnant women (RR=0.79); however, due to elevated suicide and homicide rates, women aged 15-24 had an increased risk for violent death after abortions (RR=3.17). Our results support the healthy pregnant woman effect for all pregnancies. The protective effect of delivery can also be seen in the low rate of violent deaths, but the elevated risk of a violent death after an abortion should be taken into account in the provision of health care and social services.

Learning Objectives:

Keywords: MCH Epidemiology, Methodology

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Maternal and Child Health Epidemiology: Data for Programs and Policy Making

The 131st Annual Meeting (November 15-19, 2003) of APHA