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Co-morbidities prove large risk factor for maternal deaths

Extra care needed for women with pre-existing conditions

Jo Carlowe

Monday, 12 January 2015

Medical co-morbidities are an important factor associated with direct maternal deaths.

This is the finding from a new study* published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG)

The research, led by the National Perinatal Epidemiology Unit at the University of Oxford, used data from the recent MBRRACE Confidential Enquiry into Maternal Deaths and data on women who survived severe complications during pregnancy and childbirth from the UK Obstetric Surveillance System (UKOSS).

The scientists looked at 135 women who died between 2009 and 2012 and a control group of 1,661 women who survived a severe life-threatening complication and examined factors associated with maternal death from direct pregnancy complications.

Five major causes of direct maternal deaths in the UK were included in the analysis: eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism (AFE) and peripartum haemorrhage.

The researchers identified six factors found to be associated with maternal death after controlling for other variables. They found that 70% of the increased risk associated with maternal death could be attributed to these factors, the most important being medical co-morbidities, followed by previous pregnancy problems, hypertensive disorders of pregnancy, inadequate use of antenatal care, substance misuse and Indian ethnicity.

Specific medical co-morbidities, such as asthma, autoimmune diseases, inflammatory/atopic disorders, mental health problems, essential hypertension, haematological disorders, musculoskeletal disorders and infections, were found to be associated with a higher risk of dying from the conditions included in this study. Medical co-morbidities contributed 49% of the increased risk of fatality in the study population.

Commenting, Professor Marian Knight from the National Perinatal Epidemiology Unit at the University of Oxford and co-author of the paper said: “The findings highlight the importance of optimal care for women with pre-existing medical problems in pregnancy. We found that uptake of antenatal care was poorer among women with medical co-morbidities which could increase adverse effects associated with these conditions. It is therefore vital that this group of women receive pre-conception counselling and extra support throughout their pregnancy.

“Further studies are needed to understand whether specific aspects of care could be improved to reduce maternal deaths among women in the UK, specifically amongst those women with one or more medical conditions.”

John Thorp, BJOG Deputy-Editor-in-Chief, said: “Timely identification and appropriate management of factors that increase the risk of progression from severe maternal morbidity to mortality have the potential to improve pregnancy care and prevent deaths.”

* M Nair, et al. Factors associated with maternal death from direct pregnancy complications: a UK national case–control study. BJOG: An International Journal of Obstetrics & Gynaecology. Article first published online: 9 JAN 2015. DOI: 10.1111/1471-0528.13279

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