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.