IJE Advance Access originally published online on February 14, 2008
International Journal of Epidemiology 2008 37(2):397-404; doi:10.1093/ije/dym274
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Duration and magnitude of mortality after pregnancy in rural Bangladesh
1 Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
2 Health and Demographic Surveillance Unit, International Centre for Diarrhoeal Diseases Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh.
3 Epidemiology Unit, Public Health Department, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium.
4 Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
* Corresponding author. Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. E-mail: Lisa.Hurt{at}lshtm.ac.uk
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Abstract |
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Background Women remain at increased risk of mortality for some time after pregnancy although the length of this period is unclear. The aim of this study is to examine mortality after pregnancy in rural Bangladesh using data from a unique demographic surveillance system.
Methods We included all person-time in women aged 15–50 between 1983 and 2001 and compared mortality rates by time since pregnancy outcome (live birth, stillbirth, induced and spontaneous abortion) using Poisson regression, adjusting for socio-demographic factors.
Results Mortality was highest on the first day after pregnancy (adjusted RR compared with third to fourth year post-partum 105.74, 95% CI: 76.08, 146.95) and remained elevated until 180 days (adjusted RR 1.55, 95% CI: 1.13, 2.11). Pregnancies ending in abortions and stillbirths accounted for 50% of deaths in women within 6 weeks of the end of pregnancy, and mortality after these outcomes was between two and four times as high as mortality after a livebirth.
Conclusion The high mortality rates immediately after birth provide strong support for a skilled attendance strategy. After abortions or stillbirths, women should be under surveillance for up to 1 week. Further work on the cause of deaths in the late post-partum period is required to understand the mechanisms behind increased mortality risks at these times.
Keywords Abortion induced, abortion spontaneous, maternal mortality, parturition, post-partum period, pregnancy outcome, stillbirth
Accepted 10 December 2007