Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: A prospective longitudinal cohort analysis

Melissa Bauserman, Adrien Lokangaka, Vanessa Thorsten, Antoinette Tshefu, Shivaprasad S. Goudar, Fabian Esamai, Ana Garces, Sarah Saleem, Omrana Pasha, Archana Patel, Albert Manasyan, Mabel Berrueta, Bhala Kodkany, Elwyn Chomba, Edward A. Liechty, K. Michael Hambidge, Nancy F. Krebs, Richard J. Derman, Patricia L. Hibberd, Fernando AlthabeWaldemar A. Carlo, Marion Koso-Thomas, Robert L. Goldenberg, Dennis D. Wallace, Elizabeth M. McClure, Carl L. Bose

Research output: Contribution to journalReview article

28 Citations (Scopus)

Abstract

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 multi-national 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.

Original languageEnglish (US)
Article numberS5
JournalReproductive Health
Volume12
Issue number2
DOIs
StatePublished - Jun 8 2015

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Maternal Death
Maternal Mortality
Cohort Studies
Registries
Pregnancy
Mothers
Education
Prenatal Care
Pregnancy Complications
Mortality
Live Birth
Women's Health
Cesarean Section
Postpartum Period
Linear Models
Public Health

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries : A prospective longitudinal cohort analysis. / Bauserman, Melissa; Lokangaka, Adrien; Thorsten, Vanessa; Tshefu, Antoinette; Goudar, Shivaprasad S.; Esamai, Fabian; Garces, Ana; Saleem, Sarah; Pasha, Omrana; Patel, Archana; Manasyan, Albert; Berrueta, Mabel; Kodkany, Bhala; Chomba, Elwyn; Liechty, Edward A.; Michael Hambidge, K.; Krebs, Nancy F.; Derman, Richard J.; Hibberd, Patricia L.; Althabe, Fernando; Carlo, Waldemar A.; Koso-Thomas, Marion; Goldenberg, Robert L.; Wallace, Dennis D.; McClure, Elizabeth M.; Bose, Carl L.

In: Reproductive Health, Vol. 12, No. 2, S5, 08.06.2015.

Research output: Contribution to journalReview article

Bauserman, M, Lokangaka, A, Thorsten, V, Tshefu, A, Goudar, SS, Esamai, F, Garces, A, Saleem, S, Pasha, O, Patel, A, Manasyan, A, Berrueta, M, Kodkany, B, Chomba, E, Liechty, EA, Michael Hambidge, K, Krebs, NF, Derman, RJ, Hibberd, PL, Althabe, F, Carlo, WA, Koso-Thomas, M, Goldenberg, RL, Wallace, DD, McClure, EM & Bose, CL 2015, 'Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: A prospective longitudinal cohort analysis', Reproductive Health, vol. 12, no. 2, S5. https://doi.org/10.1186/1742-4755-12-S2-S5
Bauserman, Melissa ; Lokangaka, Adrien ; Thorsten, Vanessa ; Tshefu, Antoinette ; Goudar, Shivaprasad S. ; Esamai, Fabian ; Garces, Ana ; Saleem, Sarah ; Pasha, Omrana ; Patel, Archana ; Manasyan, Albert ; Berrueta, Mabel ; Kodkany, Bhala ; Chomba, Elwyn ; Liechty, Edward A. ; Michael Hambidge, K. ; Krebs, Nancy F. ; Derman, Richard J. ; Hibberd, Patricia L. ; Althabe, Fernando ; Carlo, Waldemar A. ; Koso-Thomas, Marion ; Goldenberg, Robert L. ; Wallace, Dennis D. ; McClure, Elizabeth M. ; Bose, Carl L. / Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries : A prospective longitudinal cohort analysis. In: Reproductive Health. 2015 ; Vol. 12, No. 2.
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abstract = "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 multi-national 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.",
author = "Melissa Bauserman and Adrien Lokangaka and Vanessa Thorsten and Antoinette Tshefu and Goudar, {Shivaprasad S.} and Fabian Esamai and Ana Garces and Sarah Saleem and Omrana Pasha and Archana Patel and Albert Manasyan and Mabel Berrueta and Bhala Kodkany and Elwyn Chomba and Liechty, {Edward A.} and {Michael Hambidge}, K. and Krebs, {Nancy F.} and Derman, {Richard J.} and Hibberd, {Patricia L.} and Fernando Althabe and Carlo, {Waldemar A.} and Marion Koso-Thomas and Goldenberg, {Robert L.} and Wallace, {Dennis D.} and McClure, {Elizabeth M.} and Bose, {Carl L.}",
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TY - JOUR

T1 - Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries

T2 - A prospective longitudinal cohort analysis

AU - Bauserman, Melissa

AU - Lokangaka, Adrien

AU - Thorsten, Vanessa

AU - Tshefu, Antoinette

AU - Goudar, Shivaprasad S.

AU - Esamai, Fabian

AU - Garces, Ana

AU - Saleem, Sarah

AU - Pasha, Omrana

AU - Patel, Archana

AU - Manasyan, Albert

AU - Berrueta, Mabel

AU - Kodkany, Bhala

AU - Chomba, Elwyn

AU - Liechty, Edward A.

AU - Michael Hambidge, K.

AU - Krebs, Nancy F.

AU - Derman, Richard J.

AU - Hibberd, Patricia L.

AU - Althabe, Fernando

AU - Carlo, Waldemar A.

AU - Koso-Thomas, Marion

AU - Goldenberg, Robert L.

AU - Wallace, Dennis D.

AU - McClure, Elizabeth M.

AU - Bose, Carl L.

PY - 2015/6/8

Y1 - 2015/6/8

N2 - 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 multi-national 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.

AB - 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 multi-national 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.

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U2 - 10.1186/1742-4755-12-S2-S5

DO - 10.1186/1742-4755-12-S2-S5

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