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


METHODS
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).


CONCLUSIONS
Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.
National Research and Development Centre for Welfare and Health, Information Division, Helsinki, Finland. mika.kissler@stakes.fi
Mika
M
Gissler
Cynthia
C
Berg
Marie-Hélène
MH
Bouvier-Colle
Pierre
P
Buekens
D000028:Abortion, Induced / Q000401:mortality; D000022:Abortion, Spontaneous / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D015984:Causality; D002423:Cause of Death / Q000639:trends; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality; D011271:Pregnancy, Ectopic / Q000401:mortality