-
JAMA Jul 2023Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for... (Observational Study)
Observational Study
IMPORTANCE
Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for all states by racial and ethnic groups were estimated.
OBJECTIVE
To quantify trends in MMRs (maternal deaths per 100 000 live births) by state for 5 mutually exclusive racial and ethnic groups using a bayesian extension of the generalized linear model network.
DESIGN, SETTING, AND PARTICIPANTS
Observational study using vital registration and census data from 1999 to 2019 in the US. Pregnant or recently pregnant individuals aged 10 to 54 years were included.
MAIN OUTCOMES AND MEASURES
MMRs.
RESULTS
In 2019, MMRs in most states were higher among American Indian and Alaska Native and Black populations than among Asian, Native Hawaiian, or Other Pacific Islander; Hispanic; and White populations. Between 1999 and 2019, observed median state MMRs increased from 14.0 (IQR, 5.7-23.9) to 49.2 (IQR, 14.4-88.0) among the American Indian and Alaska Native population, 26.7 (IQR, 18.3-32.9) to 55.4 (IQR, 31.6-74.5) among the Black population, 9.6 (IQR, 5.7-12.6) to 20.9 (IQR, 12.1-32.8) among the Asian, Native Hawaiian, or Other Pacific Islander population, 9.6 (IQR, 6.9-11.6) to 19.1 (IQR, 11.6-24.9) among the Hispanic population, and 9.4 (IQR, 7.4-11.4) to 26.3 (IQR, 20.3-33.3) among the White population. In each year between 1999 and 2019, the Black population had the highest median state MMR. The American Indian and Alaska Native population had the largest increases in median state MMRs between 1999 and 2019. Since 1999, the median of state MMRs has increased for all racial and ethnic groups in the US and the American Indian and Alaska Native; Asian, Native Hawaiian, or Other Pacific Islander; and Black populations each observed their highest median state MMRs in 2019.
CONCLUSION AND RELEVANCE
While maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted. Median state MMRs for the American Indian and Alaska Native and Asian, Native Hawaiian, or Other Pacific Islander populations continue to increase, even after the adoption of a pregnancy checkbox on death certificates. Median state MMR for the Black population remains the highest in the US. Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups with the greatest potential to improve maternal mortality. Maternal mortality persists as a source of worsening disparities in many US states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis.
Topics: Female; Humans; Pregnancy; Bayes Theorem; Ethnicity; Maternal Mortality; Racial Groups; United States; Child; Adolescent; Young Adult; Adult; Middle Aged
PubMed: 37395772
DOI: 10.1001/jama.2023.9043 -
Public Health Action Aug 2023Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans...
BACKGROUND
Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans Frontières supports a referral maternity ward in the capital, Bangui.
OBJECTIVES
To describe the prevalence, associated factors and fatality of one of the most severe complications, uterine rupture, as well as the effect of a history of uterine surgery.
METHODS
This is a cross-sectional study based on retrospectively collected data between January 2018 and December 2021 for women who delivered new-borns weighing over 1,000 g.
RESULTS
Of 38,782 deliveries, 229 (0.6%) cases of uterine rupture were recorded. Factors associated with uterine rupture were parity ⩾5 (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 4.6-12.2), non-occipital foetal presentation (aOR 2.8, 95% CI 2.1-3.7) and macrosomia (OR 4, 95% CI 2.6-6.4). The fatality rate was 4.4%, and the stillbirth rate was 64%. Uterine rupture occurred in non-scarred uterus in 150 (66.1%) women. Adverse outcomes were more common in cases of uterine rupture on non-scarred uterus compared to scarred uterus, with higher maternal mortality (6% vs. 0%, = 0.023) and lower Apgar scores (<2) for new-borns (69.1% vs. 45.8%, < 0.001).
CONCLUSION
Uterine rupture remains a major issue for maternal and perinatal health in the CAR, and efforts are needed to early detect risk factors and increase coverage of the comprehensive emergency obstetric and neonatal care.
PubMed: 37529553
DOI: 10.5588/pha.23.0004 -
American Journal of Public Health May 2024
Topics: Humans; Female; Public Health; Maternal Mortality; Pregnancy
PubMed: 38748962
DOI: 10.2105/AJPH.2024.307693 -
Case Reports in Women's Health Sep 2023
PubMed: 37954228
DOI: 10.1016/j.crwh.2023.e00542 -
Journal of Obstetrics and Gynaecology :... Dec 2023Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that... (Meta-Analysis)
Meta-Analysis
Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.
Topics: Female; Humans; Infant, Newborn; Pregnancy; COVID-19; Infectious Disease Transmission, Vertical; Perinatal Death; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; SARS-CoV-2; Maternal Mortality; Intensive Care Units, Neonatal; Patient Admission
PubMed: 36651606
DOI: 10.1080/01443615.2022.2162867