Christian Parul, Katz Joanne, Wu Lee, Kimbrough-Pradhan Elizabeth, Khatry Subarna K, LeClerq Steven C, West Keith 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.
Public Health. 2008 Feb;122(2):161-72. doi: 10.1016/j.puhe.2007.06.003. Epub 2007 Sep 10.
This study examined the risk factors of mortality related to pregnancy for the first year post partum in a cohort of 25,580 pregnancies.
Longitudinal cohort follow-up.
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.
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.
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.
本研究在一个包含25580例妊娠的队列中，调查产后第一年与妊娠相关的死亡风险因素。
纵向队列随访。
在妊娠早期至中期收集社会经济状况、上臂中部周长（MUAC）、饮食、疾病、工作、物质使用及既往妊娠史等详细信息，并对这些女性进行产后1年的随访。计算每10万例妊娠中在孕期或产后42天内（早期）以及产后43 - 364天（晚期）的全因死亡率。使用五组风险因素估计死亡比值比（OR）：生物学因素；发病率；饮食；生活方式；以及社会经济因素。每个时间段内的显著因素被纳入每个时间段的单一风险模型。
早期和晚期与妊娠相关的死亡率分别为469[95%置信区间（CI）385 - 553]和254（95%CI 192 - 316）。母亲年龄≥35岁与死亡率增加三至四倍相关，而产次增加则提供了更大的保护。在最终模型中，较大的MUAC和深绿叶蔬菜的摄入与早期死亡风险降低相关（OR分别为0.76，95%CI 0.67 - 0.87和0.64，95%CI 0.41 - 0.99）。较大的MUAC在晚期也与较低的死亡风险相关。腹泻/痢疾和先兆子痫与早期死亡风险增加相关（OR分别为2.78，95%CI 1.40 - 5.51和2.95，95%CI 1.48 - 5.90）。在两个时间段中与死亡率弱相关（P<0.1）的因素包括夜盲、剧烈工作活动和吸烟。在模型中没有社会经济因素具有显著性。
尼泊尔农村地区妊娠早期至中期的母亲年龄、产次、MUAC饮食和疾病与孕期及产后第一年的死亡风险相关。
