Risk factors for pregnancy-related mortality: a prospective study in rural Nepal.
OBJECTIVE
This study examined the risk factors of mortality related to pregnancy for the first year post partum in a cohort of 25,580 pregnancies.


METHODS
Longitudinal cohort follow-up.


METHODS
Details of socio-economic status, mid-upper arm circumference (MUAC), diet, illness, work, substance use and previous pregnancy history were collected during early to mid-gestation, and these women were followed for 1 year post partum. All-cause mortality rates per 100,000 pregnancies were calculated for deaths during pregnancy or up to 42 days post partum (early period) and 43-364 days post partum (late period). Odds ratios (OR) of mortality were estimated using five groups of risk factors: biological; morbidity; dietary; lifestyle; and socio-economic. Significant factors within each group were included in a single risk model for each time period.


RESULTS
Early and late pregnancy-related mortality rates were 469 [95% confidence interval (CI) 385-553] and 254 (95% CI 192-316), respectively. Maternal age > or = 35 years was associated with a three- to four-fold increase in mortality, whereas increasing parity conferred increasing protection. In the final model, a larger MUAC and consumption of dark green leaves were associated with decreased risk of death in the early period (OR 0.76, 95% CI 0.67-0.87 and 0.64, 95% CI 0.41-0.99, respectively). A larger MUAC was also associated with a lower risk of death in the late period. Diarrhoea/dysentery and pre-eclampsia were associated with increased risk of death in the early period (OR 2.78, 95% CI 1.40-5.51 and 2.95, 95% CI 1.48-5.90, respectively). Factors weakly associated (P<0.1) with mortality in both periods included night blindness, strenuous work activity and cigarette smoking. No socio-economic factors were significant in the models.


CONCLUSIONS
Maternal age, parity, MUAC, diet and illness in early to mid-gestation were associated with risk of death during pregnancy and the first year post partum in rural Nepal.
Christian
Parul
P
Department of International Health and Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Room W2041, Baltimore, MD 21205, USA. pchristi@jhsph.edu
Katz
Joanne
J
Wu
Lee
L
Kimbrough-Pradhan
Elizabeth
E
Khatry
Subarna K
SK
LeClerq
Steven C
SC
West
Keith P
KP
D001837:Body Weights and Measures; D015331:Cohort Studies; D004032:Diet / Q000706:statistics & numerical data; D019587:Dietary Supplements; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008428:Maternal Mortality; D009390:Nepal / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors