Maternal mortality is an important public health issue in developing countries. It is also widely recognised as a sensitive indicator of health system performance. But are all deaths during pregnancy directly due to child-bearing? What role do indirect causes play?

Research in Senegal co-ordinated by the London School of Hygiene and Tropical Medicine suggests that very young and older women are at particular risk during pregnancy. By contrast, many women appear to be less susceptible to ill-health during and after pregnancy than women of a similar age who are not pregnant.

The definition of maternal mortality has recently been expanded to include ‘indirect maternal deaths’. These are deaths from illnesses that may be aggravated by the physiological effects of pregnancy.

There is limited evidence to support the widely held view that pregnant women are more vulnerable to health risks. This study uses demographic surveillance information to examine the death rates and the causes of death of Senegalese women aged 15 to 50. It found that:

• Total death rates among all women increase with age, as expected.
• Among pregnant and recently-delivered women, those aged 45 - 49 have a death rate 18 times higher than women aged 35 - 39; those aged 15 - 19 are twice as likely to die as women aged 20 - 24.
• Between the ages of 20 and 44, pregnancy does not increase health risks.
• In fact, excluding deaths directly related to pregnancy, women aged 20 - 39 are less likely to die of other causes than non-pregnant women of the same age.

These striking findings contradict the usual assumptions about the vulnerability of pregnant women. Pregnancy may actually have a protective effect on women’s health. More work is needed to distinguish between direct or indirect causes of maternal mortality and deaths which are incidental to the pregnancy.

The results are supported by the few similar studies of maternal mortality. The researchers suggest three possible explanations for this apparent protective effect:

• Pregnant women may be more concerned about their health and get better care during pregnancy.
• Physiological changes during pregnancy may directly protect women from severe diseases.
• Healthier women may be more likely to become pregnant.

Source(s):
‘Evidence for a "healthy pregnant woman effect" in Niakhar, Senegal?’ by C. Ronsmans, M. Khlat, B. Kodio, M. Ba, L. de Bernis and J. Etard, International Journal of Epidemiology (in press)

id21 Research Highlight: 25 October 2002

Further Information:
Carine Ronsmans
Maternal Health Programme
Infectious Disease Epidemiology Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2190
Fax: +44 (0)20 7299 4720
Contact the contributor: carine.ronsmans@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
See id21's collection of links relevant to maternal and child health.