背景：降低孕產婦死亡率是永續發展目標3.1，但是台灣政府公告孕產婦死亡率不降反升，由2011年每十萬活產死亡數5.0增加到2019年的16.0。其中一個原因是台灣自2012年開始生育事故救濟試辦計畫，2015年12月通過《生產事故救濟條例》，2016年6月正式實施。不知道這九年的孕產婦死亡率增加，是因為相關政策造成死亡率回歸真實？還是真的有某些因素造成孕產婦死亡風險增加？
目的：以健保申報出院診斷為參考標準計算台灣2008至2020年真實孕產婦死亡率，進一步分析年齡別死亡率，直接與間接死亡原因分布。
方法：本研究採類強化監測系統，連結2008至2020健保住院申報資料與死因統計資料，以健保申報出院診斷為參考標準計算真實年齡別孕產婦死亡率，並使用年齡標準化死亡比估計孕產婦死亡率趨勢。最後估計較寬廣定義孕產婦死亡數與死因分布。
結果：由2008年到2020年官方統計孕產婦死亡數237人，參考標準估計死亡數305人，比官方統計多68人。參考標準死亡率由2011年每十萬活產死亡數10.1增加到2019年的17.7。2010至2012年參考標準與官方統計差距較大，2015與2016年相當接近，之後幾年又有相當差異。真實死亡率在2018-2020比2008-2011的死亡率比有統計顯著上升，而且每一年齡層都出現上升趨勢。以2008-2011年的年齡別孕產婦死亡率為標準，2012-2014，2015-2017與2018-2020標準化死亡比分別為1.14 (95% CI 0.90-1.42) ，1.13 (95% CI 0.89-1.40)與1.48 (95% CI 1.19-1.81)。68位官方統計低報告個案，17位是羊水栓塞，9位產後出血，8位妊娠相關高血壓疾病，8位周產期心肌炎。使用較寬廣定義，本研究發現81位死亡是間接與孕產相關，25位是心臟血管疾病，15位是腦血管疾病，11位是呼吸系統疾病。
結論：台灣官方孕產婦死亡率在2018年以前的增加主要是因為生產事故救濟政策實施導致死亡率回歸真實。但是，2018與2019年台灣孕產婦死亡率的確顯著提高，真正原因還需要進一步研究驗證。未來應該進一步關注孕產婦心血管疾病共病的處置，降低可避免死亡的發生。

This study used the inpatient diagnosis from Taiwan’s National Health Insurance Research Database as reference standard to measure the ture number of maternal death, the true maternal mortality ratio, the temporal trend of maternal mortality ratio by standardized mortality ratio (SMR), and the distribution of direct and indirect obstetric death during 2008- 2020 in Taiwan. From 2008 to 2020, the number of maternal deaths in the official statistics was 237, and the number of deaths estimated by the reference standard was 305, which was 68 more than the official statistics. The maternal mortality ratio in reference standard has increased from 10.1 per 100,000 live births in 2011 to 17.7 per 100,000 live births in 2019. there was a large discrepancy between the reference standard and the official statistics from 2010 to 2012, with a fairly close match in 2015 and 2016, and then a considerable discrepancy in the following years. The true maternal mortality ratio was statistically significantly higher in 2018-2020 than in 2008-2011, and an upward trend was observed in every age group. Using the age structure of childbirth women in 2008-2011 as a reference for the SMR analysis, the SMR were 1.14 (95% CI 0.90-1.42), 1.13 (95% CI 0.89-1.40) and 1.48 (95% CI 1.19-1.81) in 2012-2014, 2015-2017 and 2018-2020, respectively. 68 maternal death were underreported from the official statistics, incluiding 17 amniotic fluid embolisms, 9 postpartum haemorrhages, 8 pregnancy-associated hypertensive disorders, and 8 peripartum cardiomyopathy. Using a broad definition, this study found that 81 deaths were indirect obstetric death, among them, 25 were cardiovascular diseases, 15 were cerebrovascular diseases, and 11 were respiratory diseases. The increase in the official maternal mortality ratio in Taiwan prior to 2018 was not a real increase in risk, but was mainly due to the implementation of the policy of relief in case of childbirth accidents, which led to a return to the true mortality ratio. However, the maternal mortality ratio exactly increased in Taiwan between 2018 and 2019. The further research is needed to verify the true cause. In the future, more attention should be paid and more strategies should be conducted to those pregnant women with cardiovascular co-morbidities to reduce the incidence of avoidable death.

中文文獻
衛生福利部(2018)。2018 生產事故救濟報報。台北市：作者。
衛生福利部(2019)。2019 生產事故救濟報報。台北市：作者。
衛生福利部(2020)。2020 生產事故救濟報報。台北市：作者。
衛生福利部(2021)。2021 生產事故救濟報報。台北市：作者。
衛生福利部(2022)。2022 生產事故救濟報報。台北市：作者。

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