Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries.
Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries.
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南亚和撒哈拉以南非洲孕产妇直接发病率和妊娠相关死亡、死产和新生儿死亡风险：8个国家基于人群的前瞻性队列研究
DOI：
10.1371/journal.pmed.1003644
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发表时间：
2021-06
期刊：
影响因子：
15.8
通讯作者：
Alliance for Maternal and Newborn Health Improvement (AMANHI) maternal morbidity study group
中科院分区：
文献类型：
--
作者：
Aftab F;Ahmed I;Ahmed S;Ali SM;Amenga-Etego S;Ariff S;Bahl R;Baqui AH;Begum N;Bhutta ZA;Biemba G;Cousens S;Das V;Deb S;Dhingra U;Dutta A;Edmond K;Esamai F;Ghosh AK;Gisore P;Grogan C;Hamer DH;Herlihy J;Hurt L;Ilyas M;Jehan F;Juma MH;Kalonji M;Khanam R;Kirkwood BR;Kumar A;Kumar A;Kumar V;Manu A;Marete I;Mehmood U;Minckas N;Mishra S;Mitra DK;Moin MI;Muhammad K;Newton S;Ngaima S;Nguwo A;Nisar MI;Otomba J;Quaiyum MA;Sarrassat S;Sazawal S;Semrau KE;Shannon C;Singh VP;Soofi S;Soremekun S;Suleiman AM;Sunday V;Dilip TR;Tshefu A;Wasan Y;Yeboah-Antwi K;Yoshida S;Zaidi AK;Alliance for Maternal and Newborn Health Improvement (AMANHI) maternal morbidity study group
孕产妇发病率比死亡率高几倍，但低收入和中等收入国家有关发病负担及其对孕产妇、胎儿和新生儿结局影响的数据有限。我们的目的是生成前瞻性、可靠的基于人群的数据，了解南亚和撒哈拉以南非洲地区产前、产时和产后期间主要直接孕产妇发病的负担及其与孕产妇、胎儿和新生儿死亡的关系。这是一项前瞻性队列研究，在南亚和撒哈拉以南非洲 8 个国家的 9 个研究中心进行。我们对育龄妇女（15 至 49 岁）进行了基于人群的监测，以确定怀孕情况。 2012 年至 2015 年，同意的孕妇被纳入研究，并随访至分娩和产后 42 天。我们使用标准操作程序、数据收集工具和培训来协调各中心的研究实施。孕期家访 3 次，产后家访 2 次，收集孕产妇发病信息以及孕产妇、胎儿和新生儿结局。我们测量血压和蛋白尿来定义妊娠期高血压疾病，并测量女性的自我报告来识别产科出血、妊娠相关感染以及产程延长或难产。怀孕持续至少 28 周或在怀孕期间死亡的女性纳入分析。我们使用荟萃分析来结合特定地点的负担估计，并使用回归分析结合所有地点的所有数据来检查孕产妇发病率和不良结果之间的关联。在研究人群中约 735,000 名育龄妇女以及研究期间怀孕的 133,238 名妇女中，只有 1.6% 的人拒绝同意。其中，114,927 例妊娠在产前和产后期间至少收集过一次发病率数据，其中 114,050 例纳入分析。总体而言，32.7% 的妊娠至少患有一种主要的直接孕产妇疾病；与撒哈拉以南非洲相比，南亚的负担几乎翻倍（南亚为 43.9%，95% CI 27.8% 至 60.0%；撒哈拉以南非洲为 23.7%，95% CI 19.8% 至 27.6%）。据报道，2.2%（95% CI 1.5%至2.9%）的妊娠发生产前出血，1.7%（95% CI 1.2%至2.2%）的妊娠发生严重产后出血。据报道，1.4%（95% CI 0.9% - 2.0%）的妊娠者患有先兆子痫或子痫，7.4%（95% CI 4.6% - 10.1%）的妊娠者仅患有妊娠高血压。据报道，大约 11.1%（95% CI 5.4% 至 16.8%）的妊娠出现产程延长或难产。 9.1% (95% CI 5.6% - 12.6%) 的妊娠存在晚期妊娠感染的临床特征，8.6% (95% CI 4.4% - 12.8%) 的妊娠存在产后感染的临床特征。每 100,000 名新生儿中有 187 例与妊娠相关的死亡，每 1,000 名新生儿中有 27 例死产，每 1,000 例活产中有 28 例新生儿死亡，具体情况因国家和地区而异。直接孕产妇发病率与这些结果均相关。我们的研究结果表明，撒哈拉以南非洲和南亚的卫生规划必须加紧努力，查明和治疗影响约三分之一妊娠的孕产妇疾病，并防止相关的孕产妇和新生儿死亡及死产。该研究不是临床试验。对严重直接孕产妇发病率的估计主要基于医院研究，其定义不一致且选择标准各不相同。南亚和撒哈拉以南非洲的数据有限，这两个地区孕产妇和新生儿发病率和死亡率最高，而且在家中分娩的比例较大。我们从撒哈拉以南非洲和南亚多个地点的社区妇女群体中收集了有关孕产妇发病率的数据。在超过 114,000 名女性的队列中，我们发现大约三分之一的女性患有孕产妇发病率，这明显高于之前报告的数据。我们发现子痫前期和子痫的患病率约为1%，低于之前报道的水平。大约 11% 的女性表示曾经历过产程延长或难产，这一数字略高于公布的估计值。南亚地区产后妊娠相关感染的负担高于撒哈拉以南非洲地区。据我们所知，这是第一项描述产前出血和晚期产前感染的负担并清楚地证明直接孕产妇发病率与不良妊娠结局之间关系的研究。孕产妇直接发病率的较高负担及其与不良后果的关联凸显了改善妇女和母亲健康的必要性，包括促进孕前健康和营养，以及高质量的产前、产时和产后护理。
Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. The study is not a clinical trial. Estimates of severe direct maternal morbidity are largely based on hospital-based studies with inconsistent definitions and varying selection criteria. Limited data are available from South Asia and sub-Saharan Africa, the 2 regions with the highest maternal and newborn morbidity and mortality, where a larger proportion of births occur at home. We collected data on maternal morbidities from a cohort of women in the community in multiple sites in sub-Saharan Africa and in South Asia. Out of a cohort of >114,000 women, we found that about 1 in 3 women suffer a maternal morbidity, which was notably higher than the previously reported data. We found that the prevalence of preeclampsia and eclampsia was about 1%, which was lower than previously reported. About 11% of women reported having prolonged or obstructed labour, which was somewhat higher than published estimates. The burden of pregnancy-related infection in postpartum period was higher in South Asia than in sub-Saharan Africa. This is the first study, to our knowledge, to describe the burden of antepartum haemorrhage and late antepartum infection and to clearly demonstrate the association of direct maternal morbidity with adverse pregnancy outcomes. Higher burden of direct maternal morbidity and its association with adverse outcomes highlights the need for improving health of women and mothers, including promotion of preconception health and nutrition, and high-quality antepartum, intrapartum and postpartum care.
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影响因子：
34.3
作者：
Semrau, Katherine E. A.;Herlihy, Julie;Hamer, Davidson H.
通讯作者：
Hamer, Davidson H.
影响因子：
15.8
作者：
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通讯作者：
von Dadelszen, Peter
DOI：
10.1111/1471-0528.12629
发表时间：
2014-03-01
影响因子：
5.8
作者：
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通讯作者：
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母体发病率的频率：系统评价的系统评价。
DOI：
10.1002/ijgo.12468
发表时间：
2018-05
期刊：
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
影响因子：
--
作者：
Gon G;Leite A;Calvert C;Woodd S;Graham WJ;Filippi V
通讯作者：
Filippi V
影响因子：
2.1
作者：
Ronsmans, C;Achadi, E;Zazri, A
通讯作者：
Zazri, A