Mortality in mothers after perinatal loss: a population-based follow-up study

ObjectiveTo assess whether mothers who lost a child from stillbirth or in the first week of life have an increased overall mortality and cause-specific mortality. DesignA population based follow-up study. SettingData from Danish national registers. PopulationAll mothers in Denmark were included in the cohort at time of their first delivery from 1 January 1980 to 31 December 2008 and followed until 31 December 2009 or death, whichever came first. MethodsThe association between perinatal loss and total and cause-specific mortality in mothers was estimated with hazard ratios (HR) and 95% confidence intervals (95% CI) calculated using Cox proportional hazards regression analyses. Main outcome measuresOverall mortality and cause-specific mortality. ResultsDuring the follow-up period, 838331 mothers in the cohort gave birth to one or more children and 7690 mothers (0.92%) experienced a perinatal loss. During follow-up, 8883 mothers (1.06%) died. There was an increased overall mortality for mothers who experienced a perinatal loss adjusted for maternal age and educational level, hazard ratio (HR) 1.83 [95% confidence interval (CI) 1.55-2.17]. The strongest association was seen in mortality from cardiovascular diseases (CVD) with an HR of 2.29 (95% CI 1.48-3.52) adjusted for CVD at time of delivery. We found no association between a perinatal loss and mortality from traumatic causes. ConclusionsMothers who experience a perinatal loss have an increased mortality, especially from CVD.