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Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000

  • Mika Gissler
    Correspondence
    Reprint requests: Mika Gissler, DrPhil, National Research and Development Centre for Welfare and Health, PO Box 220, Helsinki, Finland.
    Affiliations
    STAKES (National Research and Development Centre for Welfare and Health), Information Division,a Helsinki, Finland, Division of Reproductive Health, Centers for Disease Control and Prevention,b Atlanta, Ga, Institut National de la Santé et de la Recherche Médicale U 149 Epidemiological Research Unit on Perinatal and Women's Health,c Paris, France, School of Public Health and Tropical medicine, Tulane University, New Orleans, Lad USA
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  • Cynthia Berg
    Affiliations
    STAKES (National Research and Development Centre for Welfare and Health), Information Division,a Helsinki, Finland, Division of Reproductive Health, Centers for Disease Control and Prevention,b Atlanta, Ga, Institut National de la Santé et de la Recherche Médicale U 149 Epidemiological Research Unit on Perinatal and Women's Health,c Paris, France, School of Public Health and Tropical medicine, Tulane University, New Orleans, Lad USA
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  • Marie-Hélène Bouvier-Colle
    Affiliations
    STAKES (National Research and Development Centre for Welfare and Health), Information Division,a Helsinki, Finland, Division of Reproductive Health, Centers for Disease Control and Prevention,b Atlanta, Ga, Institut National de la Santé et de la Recherche Médicale U 149 Epidemiological Research Unit on Perinatal and Women's Health,c Paris, France, School of Public Health and Tropical medicine, Tulane University, New Orleans, Lad USA
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  • Pierre Buekens
    Affiliations
    STAKES (National Research and Development Centre for Welfare and Health), Information Division,a Helsinki, Finland, Division of Reproductive Health, Centers for Disease Control and Prevention,b Atlanta, Ga, Institut National de la Santé et de la Recherche Médicale U 149 Epidemiological Research Unit on Perinatal and Women's Health,c Paris, France, School of Public Health and Tropical medicine, Tulane University, New Orleans, Lad USA
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      Abstract

      Objective

      To test the hypothesis that pregnant and recently pregnant women enjoy a “healthy pregnant women effect,” we compared the all natural cause mortality rates for women who were pregnant or within 1 year of pregnancy termination with all other women of reproductive age.

      Study design

      This is a population-based, retrospective cohort study from Finland for a 14-year period, 1987 to 2000. Information on all deaths of women aged 15 to 49 years in Finland (n = 15,823) was received from the Cause-of-Death Register and linked to the Medical Birth Register (n = 865,988 live births and stillbirths), the Register on Induced Abortions (n = 156,789 induced abortions), and the Hospital Discharge Register (n = 118,490 spontaneous abortions) to identify pregnancy-associated deaths (n = 419).

      Results

      The age-adjusted mortality rate for women during pregnancy and within 1 year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women, 57.0 per 100,000 person-years (relative risk [RR] 0.64, 95% CI 0.58-0.71). The mortality was lower after a birth (28.2/100,000) than after a spontaneous (51.9/100,000) or induced abortion (83.1/100,000). We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15 to 24 years (RR 4.08, 95% CI 1.58-10.55).

      Conclusion

      Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.

      Keywords

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      References

      1. Organization for Economic Cooperation and Development. OECD health data 2002.
        The Organization, Paris2002
        • Gissler M
        • Kauppila R
        • Meriläinen J
        • Toukomaa H
        • Hemminki E
        Pregnancy-associated deaths in Finland in 1987-1994—definition problems and benefits of record linkage.
        Acta Obstet Gynaecol Scand. 1997; 76: 651-657
        • Berg C
        • Danel I
        • Atrash H
        • Zane S
        • Bartlett L
        Strategies to reduce pregnancy-related deaths: from identification and review to action.
        Centers for Disease Control and Prevention, Atlanta2001
        • Atrash H.K
        • Alexander S
        • Berg C.J
        Maternal mortality in developed countries: not just a concern of the past.
        Obstet Gynecol. 1995; 86: 700-705
        • Wilcox L.S
        • Marks J.S
        From data to action: CDC's public health surveillance for women, infants and children.
        US Department of Health and Human Services, Bethesda1995
        • Salanave B
        • Bouvier-Colle M.-H
        • Varnoux N
        • Alexander S
        • Mcfarlane A
        Classification differences and maternal mortality: a European study MOMS Group.
        Int J Epidemiol. 1999; 28: 64-69
        • Ronsmans C
        • Khlat M
        • Kodio B
        • Ba M
        • De Bernis L
        • Etard J
        Evidence for a “healthy pregnant woman effect” in Niakhar, Senegal?.
        Int J Epidemiol. 2001; 30: 467-473
        • Turner L.A
        • Kramer M.S
        • Liu S
        Maternal Mortality and Morbidity Study Group of the Canadian Perinatal Surveillance System: Cause-specific mortality during and after pregnancy and the definition of maternal death.
        Chronic Dis Can. 2002; 23: 31-36
        • Gissler M
        • Teperi J
        • Hemminki E
        • Meriläinen J
        Data quality after restructuring a nationwide medical birth registry.
        Scand J Soc Med. 1995; 23: 75-80
        • Gissler M
        • Ulander V.-M
        • Hemminki E
        • Rasimus A
        Declining induced abortion rate in Finland: data-quality of the Abortion Register.
        Int J Epidemiol. 1996; 25: 376-380
        • Keskimäki I
        • Aro S
        Accuracy of data on diagnoses, procedures and accidents in the Finnish Hospital Discharge Register.
        Int J Health Sci. 1991; 2: 15-21
        • Hemminki E
        Treatment of miscarriage: current practice and rationale.
        Obstet Gynecol. 1998; 91: 247-253
        • World Health Organization
        10th revision. International statistical classification of diseases and related health problems. Volume 1. World Health Organization, Geneva1992
        • Henry O.A
        • Sheedy M.T
        • Beischer N.A
        When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne.
        Med J Aust. 1989; 151: 628-631
        • Barnet C
        • Bouvier-Colle M.H
        Mortalité féminine et activité professionnelle en France (comparaison 1975-1982).
        Rev Epidemiol Sante Publique. 1986; 34: 345-352
        • Mc Avoy B.R
        Death after bereavement.
        BMJ. 1986; 293: 835-836
        • Moser K.A
        • Pugh H.S
        • Goldblatt P.O
        Inequalities in women's health in England and Wales: mortality among married women according to social circumstances employment and life-cycle stage.
        Genus. 1990; 46: 71-84
        • Waldron I
        • Hughes M.E
        • Brooks T.L
        Marriage protection and marriage selection prospective evidence for reciprocal effects of marital status and health.
        Soc Sci Med. 1996; 43: 113-123
        • Council of Europe
        Recent demographic developments in Europe.
        Council of Europe, Strasbourg1999
        • Martin J.A
        • Park M.M
        • Sutton P.D
        Births: preliminary data for 2001.
        Natl Vital Stat Rep. 2001; 50: 1-20
        • Fox A.J
        • Goldblatt P.O
        • Jones D.R
        Social class mortality differentials: artifact, selection or life circumstances.
        J Epidemiol Community Health. 1985; 39: 1-8
        • Vallin J
        • Nizard A
        La mortalité par état matrimonial: mariage sélection ou mariage protection?.
        Population. 1977; 32: 95-121
        • Lewis G
        Why mothers die 1997-1999: confidential enquiries into maternal deaths in the United Kingdom.
        RCOG Press, London2001
        • Schuitemaker N.W.E
        • Bennebroek-Gravenhorst J
        • Van Geijn H.P
        • Dekker G.A
        • Vandongen P.W.J
        Maternal mortality and its prevention.
        Eur J Obstet Gynecol Reprod Biol. 1991; 42: S31-S35
        • Bouvier-Colle M.H
        • Varnoux N
        • Bréart G
        • Medical Experts Committee
        Maternal deaths and substandard care: the results of a confidential survey in France.
        Eur J Obstet Gynecol Reprod Biol. 1995; 58: 3-7