Evidence for a 'healthy pregnant woman effect' in Niakhar, Senegal?

Background Although it is generally believed that pregnancy exposes women t o a wide variety of excess health risks that go beyond the direct obstetric complications of pregnancy, the epidemiological evidence in support of suc h excess indirect risks is inconclusive. In this article we attempt to docu ment the contribution of indirect causes of death to maternal mortality in rural Senegal by using an epidemiological approach whereby the time spent d uring pregnancy and postpartum is considered a transient period of exposure to the health hazards of childbearing. Methods We use data from an ongoing demographic surveillance system in Niak har, Senegal and calculate rate ratios comparing death rates in pregnant or recently pregnant women (exposed) with death rates in other women (unexpos ed), including and excluding direct obstetric deaths. Results Between ages 20 and 44, pregnancy does not confer additional risks to women. After excluding direct obstetric deaths, exposed women aged 20-39 have surprisingly lower risks of death than unexposed women of the same ag e. For the very young (15-19) and the very old (45-49), on the other hand, the excess risks associated with pregnancy are considerable and, among wome n age 45 or older, persist even after excluding direct obstetric deaths. Conclusion The apparent protective effect of pregnancy on women's health th at is observed in this study illustrates the paradoxical nature of the conc ept of indirect causes of maternal mortality, and the difficulties in measu ring the risks of death attributable to the pregnancy Further studies aimed at separating risks attributable to the pregnancy from those that are inci dental to the pregnancy are required.