Article title: Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis
From SAGE Open Medicine
Maternal deaths associated with pregnancy are a major public health concern. Death rate calculations based on death certificates alone, however, consistently miss cases. This is a systematic review of all the medical literature dealing with deaths during or following pregnancy that employed record linkage techniques. The findings are consistent with a body of literature indicating that pregnancy loss (both natural and induced) contributes to increased levels of stress and psychological effects that may negatively impact health and longevity. The heightened risk of premature death is elevated for 10 years following pregnancy loss. Both miscarriage and termination of pregnancy are markers for reduced life expectancy. It is suggested that generally births have a positive effect on longevity while pregnancy losses have a negative effect. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors. Authors recommend that the American Psychological Association’s list of risk factors for identifying women who are most likely to experience high levels of stress and more negative psychological reactions following pregnancy loss should be used when treating women with any history of abortion or miscarriage in order to better identify the high risk women who may most benefit from additional counseling and other interventions.
Measures of pregnancy associated deaths provide important guidance for public health initiatives. Record linkage studies have significantly improved identification of deaths associated with childbirth but relatively few have also examined deaths associated with pregnancy loss even though higher rates of maternal death have been associated with the latter. Following PRISMA guidelines we undertook a systematic review of record linkage studies examining the relative mortality risks associated with pregnancy loss to develop a narrative synthesis, a meta-analysis, and to identify research opportunities.
MEDLINE and SCOPUS were searched in July 2015 using combinations of: mortality, maternal death, record linkage, linked records, pregnancy associated mortality, and pregnancy associated death to identify papers using linkage of death certificates to independent records identifying pregnancy outcomes. Additional studies were identified by examining all citations for relevant studies.
Of 989 studies, 11 studies from three countries reported mortality rates associated with termination of pregnancy, miscarriage or failed pregnancy. Within a year of their pregnancy outcomes, women experiencing a pregnancy loss are over twice as likely to die compared to women giving birth. The heightened risk is apparent within 180 days and remains elevated for many years. There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors.
Both miscarriage and termination of pregnancy are markers for reduced life expectancy. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors.
Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis
David C Reardon, John M Thorp
First Published November 13, 2017
From SAGE Open Medicine