ObjectiveThe objective of this study is to assess associations between pregnancy complications and pregnancy‐associated maternal mortality (PAM) within 1 year after childbirth.DesignPopulation‐based cohort study.SettingNorway, 1967–2020.Population1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967–2019 and followed in the Cause of Death Registry to 2020.MethodsLogistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions.Main Outcome MeasuresPAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension.ResultsCrude OR for PAM was 4.24 (95% CI 3.53–5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08–3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20–11.72), preeclampsia: 4.42 (3.17–6.15), preterm birth: 4.32 (3.25–5.75), perinatal death: 24.18 (16.66–35.08), small for gestational age: 2.90 (1.85–4.54), gestational diabetes: 1.43 (0.63–3.25) and pregnancy hypertension: 2.05 (1.12–3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999–2019: one complication; 4.14 [2.79–6.13], two complications; 11.50 [6.81–19.43]).ConclusionComplications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy.

中文翻译：

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分娩后一年内与妊娠相关的孕产妇死亡率：基于人群的队列研究


目的本研究的目的是评估妊娠并发症与产后 1 年内妊娠相关孕产妇死亡率 （PAM） 之间的关联。设计基于人群的队列研究。地点挪威，1967-2020.人口1 237 254 名在医学出生登记处登记的一次或多次单胎妊娠的母亲，1967-2019 年在死因登记处跟踪到 2020 年。主要结局指标按妊娠并发症终生史划分的 PAM： 胎盘早剥、子痫前期、早产、围产期死亡、小于胎龄儿 （< 2.5 个百分位数）、妊娠糖尿病和妊娠高血压。结果如果并发症发生在最后一次妊娠，PAM 的粗 OR 为 4.24 （95% CI 3.53-5.10），而如果并发症发生在第一次妊娠，则为 2.52 （2.08-3.06），与在任何妊娠中没有并发症的母亲相比。当末次妊娠发生并发症时，PAM 的调整 OR 为胎盘早剥 3.75 （1.20-11.72），子痫前期：4.42 （3.17-6.15），早产：4.32 （3.25-5.75），围产期死亡：24.18 （16.66-35.08），小于胎龄儿：2.90 （1.85-4.54），妊娠糖尿病：1.43 （0.63-3.25） 和妊娠高血压：2.05 （1.12-3.74）与无并发症的母亲相比。PAM 的 OR 因复杂妊娠数量的增加而略有增加，但末次妊娠并发症数量增加的趋势更强（例如，在 1999-2019 年期间：1 例并发症;4.14 [2.79–6.13]，2 例并发症;11.50 [6.81–19.43]）。结论末次妊娠并发症与 PAM 的相关性比初孕更强。