Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis
Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis
复制标题
DOI：
10.1186/1742-4755-12-s2-s5
复制
发表时间：
2015-01-01
影响因子：
3.4
通讯作者：
Bose, Carl L.
中科院分区：
文献类型：
--
作者：
Bauserman, Melissa;Lokangaka, Adrien;Bose, Carl L.
背景：由于低收入和中等收入国家通常无法获得描述孕产妇结局的基于人口的大型数据集，因此很难长期监测孕产妇死亡率并确定与孕产妇死亡率相关的因素。早期识别危险因素对于制定预防妊娠相关并发症的综合干预策略至关重要。我们的目标是在一个大型的多国家数据集中描述孕产妇死亡率，并确定与孕产妇死亡率相关的孕产妇、妊娠相关特征、分娩和产后特征。方法：我们收集了在跨国妇女和儿童健康研究全球网络母婴健康注册中心(MNHR)登记的妇女从2010年到2013年所有怀孕的数据。我们报告了每次怀孕死亡母亲的比例和孕产妇死亡率(MMR)。使用广义线性模型来评估潜在的医疗和社会因素与孕产妇死亡率的关系，并对与这些因素相关的相对风险进行点估计和区间估计。结果：我们记录了277,736例妊娠和402例孕产妇死亡，MMR为153/100,000活产。我们观察到MMR总数从2010年的166份增加到2013年的126份。拉丁美洲站点的MMR(91)低于亚洲和非洲站点的MMR(178)和125。根据研究地点和其他变量进行调整后，未受过正规教育(RR 3.2[1.5，6.9])、仅受过小学教育(RR 3.4[1.6，7.5])、仅受过中学教育(RR 2.5[1.1，5.7])、缺乏产前护理(RR 1.8[1.2，2.5])、剖腹产(RR 1.9[1.3，2.8])、出血(RR 3.3[2.2，5.1])、高血压疾病(RR 7.4[5.2，10.4])与更高的死亡风险相关。结论：MNHR确定了低收入和中等收入国家不同环境下孕产妇死亡的可预防原因。MNHR可用于监测公共卫生战略，并确定其与降低孕产妇死亡率之间的关联。
Background: Because large, prospective, population-based data sets describing maternal outcomes are typically not available in low-and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. Early identification of risk factors is essential to develop comprehensive intervention strategies preventing pregnancy-related complications. Our objective was to describe maternal mortality rates in a large, multi-country dataset and to determine maternal, pregnancy-related, delivery and postpartum characteristics that are associated with maternal mortality.Methods: We collected data describing all pregnancies from 2010 to 2013 among women enrolled in the multinational Global Network for Women's and Children's Health Research Maternal and Neonatal Health Registry (MNHR). We reported the proportion of mothers who died per pregnancy and the maternal mortality ratio (MMR). Generalized linear models were used to evaluate the relationship of potential medical and social factors and maternal mortality and to develop point and interval estimates of relative risk associated with these factors. Generalized estimating equations were used to account for the correlation of outcomes within cluster to develop appropriate confidence intervals.Results: We recorded 277,736 pregnancies and 402 maternal deaths for an MMR of 153/100,000 live births. We observed an improvement in the total MMR from 166 in 2010 to 126 in 2013. The MMR in Latin American sites (91) was lower than the MMR in Asian (178) and African sites (125). When adjusted for study site and the other variables, no formal education (RR 3.2 [1.5, 6.9]), primary education only (RR 3.4 [1.6, 7.5]), secondary education only (RR 2.5 [1.1, 5.7]), lack of antenatal care (RR 1.8 [1.2, 2.5]), caesarean section delivery (RR 1.9 [1.3, 2.8]), hemorrhage (RR 3.3 [2.2, 5.1]), and hypertensive disorders (RR 7.4 [5.2, 10.4]) were associated with higher risks of death.Conclusions: The MNHR identified preventable causes of maternal mortality in diverse settings in low-and middle-income countries. The MNHR can be used to monitor public health strategies and determine their association with reducing maternal mortality.