Deaths attributable to childbearing in Matlab, Bangladesh: Indirect causesof maternal mortality questioned

Little is known about the nature of diseases aggravated by pregnancy or the magnitude of mortality from causes indirectly related to pregnancy. This s tudy aims at clarifying the contribution of indirect causes to maternal mor tality by analyzing the problem from an epidemiologic perspective, using po pulation-based data from Matlab, Bangladesh, for the period 1976-1993. The time spent during pregnancy and the puerperium was considered a transitory exposure period in women's lives, and death rates were calculated for women aged 15-44 years, while exposed and while not exposed. During or shortly a fter pregnancy, death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded , the death rates among women while exposed are substantially lower than th e death rates among women while not exposed. Several interpretations of thi s finding are discussed, particularly the role of selective factors ("healt hy pregnant woman effect"?). This study highlights the complexity of the co ncept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in estimating the excess risk of death attached to pr egnancy and the puerperium.