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Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study

BMJ (Online), 2022-11, Vol.379, p.e070621-e070621 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ;2022 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. BMJ http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Distributed under a Creative Commons Attribution 4.0 International License ;Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2022 BMJ ;ISSN: 1756-1833 ;ISSN: 0959-8138 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj-2022-070621

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  • Title:
    Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study
  • Author: Diguisto, Caroline ; Saucedo, Monica ; Kallianidis, Athanasios ; Bloemenkamp, Kitty ; Bødker, Birgit ; Buoncristiano, Marta ; Donati, Serena ; Gissler, Mika ; Johansen, Marianne ; Knight, Marian ; Korbel, Miroslav ; Kristufkova, Alexandra ; Nyflot, Lill T ; Deneux-Tharaux, Catherine
  • Subjects: Amniotic fluid ; Birth certificates ; Births ; Cardiomyopathy ; Cardiovascular diseases ; Documentation ; Embolism ; Embolisms ; Ethnicity ; Hemorrhage ; Hospitals ; Identification ; International comparisons ; Ischemia ; Life Sciences ; Maternal mortality ; Medical records ; Medicin och hälsovetenskap ; Minority & ethnic groups ; Mortality ; Obstetrics ; Placenta ; Population studies ; Population-based studies ; Pregnancy ; Pregnancy complications ; Statistics ; Suicides & suicide attempts ; Surveillance ; Thromboembolism ; Vital statistics
  • Is Part Of: BMJ (Online), 2022-11, Vol.379, p.e070621-e070621
  • Description: AbstractObjectiveTo compare maternal mortality in eight countries with enhanced surveillance systems.DesignDescriptive multicountry population based study.SettingEight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia.Population297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18).Outcome measuresMaternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country’s office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women’s origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated.ResultsMethods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy.ConclusionsVariations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
  • Publisher: London: British Medical Journal Publishing Group
  • Language: English
  • Identifier: ISSN: 1756-1833
    ISSN: 0959-8138
    EISSN: 1756-1833
    DOI: 10.1136/bmj-2022-070621
  • Source: BMJ Open Access Journals
    SWEPUB Freely available online
    ProQuest Central
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