Factors associated with maternal mortality at advanced maternal age: a population‐based case–control study

Abstract

ObjectiveThis study aimed to examine the factors associated with maternal mortality among women aged ≥35 years.DesignUnmatched population based case–control study.SettingUnited Kingdom.PopulationBetween 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE‐UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005–2012).MethodsRisk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis.Main outcome measuresOdds ratios and 95% confidence intervals associated with maternal death.ResultsFive factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13–3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79–63.45), medical co‐morbidities (aOR 5.92, 95% CI 3.56–9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23–3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02–1.22).ConclusionAge was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age.Tweetable abstractSmoking is a risk factor for maternal death for those aged over 35 years.

Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

“…Among the deaths caused by an associated medical condition, half of the deaths caused by cardiac diseases (13).This nding is in accordance with our ndings that showed the presence of medical or surgical condition was associated with a 3-fold increase in the odds of postpartum death in Selangor. This nding is similar to the study conducted in the United Kingdom, where the odds of maternal mortality is seven times higher in cases with the pre-existing medical condition compared to the control group (21). Additionally, Godefay et al reported that 88% of maternal death in Northern Ethiopia had a pre-existing medical condition (22) and study conduct by Nair et al in the United Kingdom found that the odds of maternal death was six times higher in women with pre-existing medical illness (23).…”

“…A study conducted in developing countries revealed the utilisation of antenatal care and skilled delivery service has signi cantly and negatively associated with MMR (27) Similarly, our study revealed that women who received antenatal care in government facilities were less likely experiencing postpartum death compared to those received in private facilities. Correspondingly to the study conducted in the United Kingdom, the odd of death was 23 times higher for women who have inadequate use of antenatal care (21). Besides, our study also in agreement with the study conducted in Nigeria, the likelihood of death was 68% lower for mothers who booked for antenatal care (28) while in Zambia, the likelihood of experiencing maternal death was 94% less among women who completed their scheduled antenatal care visits than for those who did not (29) The nding of our study observed women who practice family planning were less likely experiencing postpartum death compared to those who did not practice family planning.…”

“…We rst multiply the desired sample size (n) by the proportion of units in each stratum. As a result, we need to select 13 cases from Gombak, 21 Nation High Commissioners Refugees (UNHCR) with a valid passport and Illegal Immigrant without a valid passport. We exclude postpartum cases with incomplete information needed for analysis.…”

Maternal Mortality in Tajikistan: Successes and Challenges

“…They are one of the leading causes of maternal mortality in Tajikistan. Chronic health diseases increase risks of complications before, during and after childbirth as studies in other research settings reported [1,4,5,[23][24][25][26][27][28][29]. The critical aspect of this study is that it highlights the obstetric transition which according to Souza, et al a shift from direct causes to indirect causes of maternal mortality that occurs when maternal mortality decreases in countries which experienced high maternal mortality in the past [29,30].…”

In reply: Rethinking general anesthesia for cesarean section

“…They state "the age range of 19-49 years is a very safe patient group" and claim that the problems of advanced maternal age are not significant. However, most parturients are in that range, and there is clear evidence of the hazards associated with advanced maternal age in that range [4].…”