Pregnancy loss and postpartum mortality in a sub-Saharan African setting

Abstract

Objective: Studies from industrialized countries report a harmful association between pregnancy loss and postpartum mortality. However, the nature of this relationship has not been established in resource limited sub-Saharan Africa. Given the potential implications of this knowledge for risk stratification and subsequent maternal health in sub-Saharan Africa, our study sought to use data from one of the continent's largest and longest running population-based cohorts to investigate the relationship between pregnancy loss and postpartum mortality. Methods: We conducted a population-based cohort study involving 25048 postpartum women from KwaZulu-Natal, South Africa. The study data was collected during biannual/triannual general household surveys, which also incorporated a pregnancy questionnaire for women who reported a pregnancy between survey waves. Pregnancy loss was defined as a pregnancy which ended in abortion, miscarriage, or stillbirth. Postpartum mortality was defined as the death of a woman, from any cause, within one year after the date that her pregnancy ended. We used a quasi-poisson regression model, adjusted for maternal age and other setting-specific predictors of postpartum mortality, to investigate the relationship between pregnancy loss and postpartum mortality. Results: The incidence of postpartum mortality was three times higher in women who experienced pregnancy loss (Adjusted Incidence Rate Ratio: 3.23, 95% Confidence Interval: 2.13-4.71), when compared with women who had live births. Conclusion: Our results reveal a clear association between pregnancy loss and increased postpartum mortality in a typical rural sub-Saharan African setting. Women who have recently experienced pregnancy loss should be targeted with a package of risk reduction interventions, including additional opportunities for medical care or psychosocial support.