Regional differences in Dutch maternal mortality

Graaf, Johanna P. de; Schutte, Joke M.; Poeran, Jashvant; Roosmalen, Jos van; Bonsel, G.J.; Steegers, Eric A.P.

doi:10.1111/j.1471-0528.2012.03283.x

Cited by 14 publications

(8 citation statements)

References 31 publications

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“…The distribution of NSS in our study population (IQR −1.13–0.77) approximately resembles the distribution of NSS across the Netherlands (IQR −0.57–0.71). The lower limit of the IQR of NSS in our study population indicates the presence of deprived neighbourhoods, which is to be expected in the urban city of Rotterdam [31]. Women from 193 different neighbourhoods were included in the study, which indicates a large neighbourhood heterogeneity within our study population.…”

Section: Discussionmentioning

confidence: 86%

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

Gootjes

Koster

Willemsen

et al. 2019

JCM

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Background: Neighbourhood deprivation is a risk factor for impaired health and adverse pregnancy outcomes. We investigated whether living in a deprived neighbourhood is associated with embryonic growth. Methods: From the Predict cohort, we studied 566 women who underwent repeated first trimester ultrasound examinations. Crown rump length (CRL; n = 1707) and embryonic volume (EV; n = 1462) were measured using three-dimensional techniques. Neighbourhood deprivation was assessed using the neighbourhood status scores (NSS) of the Dutch Social Cultural Planning office. A high NSS represents a non-deprived neighbourhood. Associations between the NSS and embryonic growth were investigated using linear mixed models. Adjustment was performed for individual-level factors: maternal age, geographic origin, educational level, BMI, folic acid supplement use, fruit and vegetable intake, alcohol use and smoking habits. Results: The NSS was negatively associated with embryonic growth: a higher score (a less deprived neighbourhood) was associated with a smaller CRL and EV; adjusted β: −0.025 (95% CI −0.046, −0.003) and adjusted β: −0.015 (95% CI −0.026, −0.003). At 11 weeks of pregnancy, we observed a 0.55 cm3 smaller EV (7.65 cm3 vs. 7.10 cm3) and 1.08 mm smaller CRL (43.14 mm vs. 42.06 mm) in the highest compared to the lowest category. Conclusion: In deprived neighbourhoods, embryos are larger than in non-deprived neighbourhoods.

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Section: Discussionmentioning

confidence: 86%

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

Gootjes

Koster

Willemsen

et al. 2019

JCM

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“…The incidence of severe PPH was analyzed per province and in the four largest cities because previous studies reported that perinatal outcomes in these cities are inferior to those in the other regions (provinces) of the Netherlands [ 19 - 21 ]. For the two largest cities, Amsterdam and Rotterdam, the incidence of severe PPH was analyzed across neighborhoods.…”

Section: Methodsmentioning

confidence: 99%

Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries

Prick

Altenstadt

Hukkelhoven

et al. 2015

BMC Pregnancy Childbirth

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BackgroundThe incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands.MethodsWe used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation.ResultsWe analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting.ConclusionsIn a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0473-8) contains supplementary material, which is available to authorized users.

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“…Between country variation of maternal mortality was the key focus of our study, but we acknowledge that national rates may mask within country variations, as previously highlighted in France and in the Netherlands. 29 30 Although the characteristics of women may vary from one region to another, a meaningful national profile of pregnant women exists, and the organisation of care and recommendations for good practice are defined according to a national standard. Furthermore, the appropriate regional categorisation may vary from one country to another; thus, in the two studies cited above, France isolated the overseas territories and the Netherlands the urban regions, in relation to each national question of healthcare organisation.…”

Section: Discussionmentioning

confidence: 99%

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

Diguisto

Saucedo

Kallianidis

et al. 2022

BMJ

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Objective To compare maternal mortality in eight countries with enhanced surveillance systems. Design Descriptive multicountry population based study. Setting Eight 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. Population 297 835 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 measures Maternal 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. Results Methods 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. Conclusions Variations 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.

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Regional differences in Dutch maternal mortality

Cited by 14 publications

References 31 publications

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries

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

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