Reardon David C, Thorp John M
Elliot Institute, Springfield, IL, USA.
Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
SAGE Open Med. 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. eCollection 2017.
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.
妊娠相关死亡的衡量指标为公共卫生举措提供了重要指导。记录链接研究显著改善了与分娩相关死亡的识别，但相对较少有研究也考察了与流产相关的死亡，尽管后者与更高的孕产妇死亡率相关。按照PRISMA指南，我们对记录链接研究进行了系统综述，以考察与流产相关的相对死亡风险，从而进行叙述性综合分析、荟萃分析，并确定研究机会。
2015年7月，我们在MEDLINE和SCOPUS数据库中进行检索，使用了以下组合关键词：死亡率、孕产妇死亡、记录链接、链接记录、妊娠相关死亡率和妊娠相关死亡，以识别利用死亡证明与确定妊娠结局的独立记录进行链接的论文。通过检查相关研究的所有引文来确定其他研究。
在989项研究中，来自三个国家的11项研究报告了与终止妊娠、流产或妊娠失败相关的死亡率。与分娩的女性相比，经历流产的女性在妊娠结局后的一年内死亡可能性高出两倍多。这种风险增加在180天内很明显，并且在许多年内一直居高不下。存在剂量效应，每次流产都与死亡风险增加相关。自杀、意外、凶杀和一些自然原因（如循环系统疾病）导致的较高死亡率可能源于压力增加和冒险行为。
流产和终止妊娠都是预期寿命缩短的标志。这种关联应为研究和新的公共卫生举措提供参考，包括对表现出已知风险因素的患者进行筛查和干预。
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