Factors associated with maternal death from direct pregnancy complications: a UK national case-control study

M Nair; J J Kurinczuk; Peter Brocklehurst; S Sellers; G Lewis; M Knight

doi:10.1111/1471-0528.13279

Factors associated with maternal death from direct pregnancy complications: a UK national case-control study

M Nair, J J Kurinczuk, Peter Brocklehurst, S Sellers, G Lewis, M Knight

Birmingham Clinical Trials Unit

Research output: Contribution to journal › Article › peer-review

50 Citations (Scopus)

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Abstract

OBJECTIVE: To investigate the factors associated with maternal death from direct pregnancy complications in the UK.

DESIGN: Unmatched case-control analysis.

SETTING: All hospitals caring for pregnant women in the UK.

POPULATION: A total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.

METHODS: Multivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.

MAIN OUTCOME MEASURES: Odds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.

RESULTS: Six factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).

CONCLUSIONS: This study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.

Original language	English
Pages (from-to)	653-662
Number of pages	10
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Volume	122
Issue number	5
Early online date	9 Jan 2015
DOIs	https://doi.org/10.1111/1471-0528.13279
Publication status	Published - Apr 2015

Keywords

Adult
Case-Control Studies
Cesarean Section
Comorbidity
Eclampsia
Embolism, Amniotic Fluid
Female
Great Britain
Humans
Maternal Death
Odds Ratio
Postpartum Hemorrhage
Pregnancy
Pregnancy Complications
Prenatal Care
Pulmonary Embolism
Risk Factors
Sepsis
Substance-Related Disorders
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

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Nair_et_al_Factors_associated_with_maternal_death_Epidemiology_2015
https://doi.org/10.1111/1471-0528.13279
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Cite this

@article{b434290a2cc94989b1cd2287b3a2b8d9,

title = "Factors associated with maternal death from direct pregnancy complications: a UK national case-control study",

abstract = "OBJECTIVE: To investigate the factors associated with maternal death from direct pregnancy complications in the UK.DESIGN: Unmatched case-control analysis.SETTING: All hospitals caring for pregnant women in the UK.POPULATION: A total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.METHODS: Multivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.MAIN OUTCOME MEASURES: Odds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.RESULTS: Six factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).CONCLUSIONS: This study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.",

keywords = "Adult, Case-Control Studies, Cesarean Section, Comorbidity, Eclampsia, Embolism, Amniotic Fluid, Female, Great Britain, Humans, Maternal Death, Odds Ratio, Postpartum Hemorrhage, Pregnancy, Pregnancy Complications, Prenatal Care, Pulmonary Embolism, Risk Factors, Sepsis, Substance-Related Disorders, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't",

author = "M Nair and Kurinczuk, {J J} and Peter Brocklehurst and S Sellers and G Lewis and M Knight",

note = "{\textcopyright}2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.",

year = "2015",

month = apr,

doi = "10.1111/1471-0528.13279",

language = "English",

volume = "122",

pages = "653--662",

journal = "BJOG: An International Journal of Obstetrics & Gynaecology",

issn = "1470-0328",

publisher = "Wiley",

number = "5",

}

TY - JOUR

T1 - Factors associated with maternal death from direct pregnancy complications

T2 - a UK national case-control study

AU - Nair, M

AU - Kurinczuk, J J

AU - Brocklehurst, Peter

AU - Sellers, S

AU - Lewis, G

AU - Knight, M

PY - 2015/4

Y1 - 2015/4

N2 - OBJECTIVE: To investigate the factors associated with maternal death from direct pregnancy complications in the UK.DESIGN: Unmatched case-control analysis.SETTING: All hospitals caring for pregnant women in the UK.POPULATION: A total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.METHODS: Multivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.MAIN OUTCOME MEASURES: Odds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.RESULTS: Six factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).CONCLUSIONS: This study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.

AB - OBJECTIVE: To investigate the factors associated with maternal death from direct pregnancy complications in the UK.DESIGN: Unmatched case-control analysis.SETTING: All hospitals caring for pregnant women in the UK.POPULATION: A total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.METHODS: Multivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.MAIN OUTCOME MEASURES: Odds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.RESULTS: Six factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).CONCLUSIONS: This study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.

KW - Adult

KW - Case-Control Studies

KW - Cesarean Section

KW - Comorbidity

KW - Eclampsia

KW - Embolism, Amniotic Fluid

KW - Female

KW - Great Britain

KW - Humans

KW - Maternal Death

KW - Odds Ratio

KW - Postpartum Hemorrhage

KW - Pregnancy

KW - Pregnancy Complications

KW - Prenatal Care

KW - Pulmonary Embolism

KW - Risk Factors

KW - Sepsis

KW - Substance-Related Disorders

KW - Journal Article

KW - Multicenter Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/1471-0528.13279

DO - 10.1111/1471-0528.13279

M3 - Article

C2 - 25573167

SN - 1470-0328

VL - 122

SP - 653

EP - 662

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

IS - 5

ER -

Factors associated with maternal death from direct pregnancy complications: a UK national case-control study

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Keywords

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