The MBRRACE-UK collaboration, led from Oxford Population Health's National Perinatal Epidemiology Unit (NPEU), has published the results of their latest UK Confidential Enquiry into Maternal Deaths and Morbidity. These annual rigorous reports are recognised as a gold standard in identifying key improvements needed for maternity services. The latest Saving Lives, Improving Mothers' Care analysis examines in detail the care of all women who died during, or up to one year after, pregnancy between 2018 and 2020 in the UK. This is the first report to include data that demonstrates the impact of the COVID-19 pandemic on maternal deaths.
The report's key findings show that:
- 229 women died during or up to six weeks after the end of their pregnancies in 2018 – 2020 from pregnancy-specific causes or conditions made worse by pregnancy, an increase of 24% compared to 2017-2019.Taking into account their surviving babies and previous children, 366 motherless children remain.
- Of the 229 women who died during or up six weeks after the end of their pregnancies, nine women died from COVID-19. Of those nine women, five were Asian women and three were Black women. Changes to maternity services and pressures because of the pandemic also contributed to some other maternal deaths.
- Black women were 3.7 times more likely to die compared to White women and Asian women were 1.8 times more likely to die compared to White women.
- A further 289 women died between six weeks and one year after the end of pregnancy. Including the deaths of 18 women who died during pregnancy or up to six weeks after pregnancy which were classified as coincidental, in total, there were 536 maternal deaths among 2,101,829 maternities.
- One in nine of the women who died had experienced severe and multiple disadvantage. The main elements of a multiple disadvantage were: a mental health diagnosis; substance misuse; and domestic abuse. The report notes that the figures reported are likely to be a minimum estimate due to inconsistencies in reporting these types of disadvantage.
- Women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy in 2020 compared to the 2017 – 2019 report. Maternal suicide was also a leading cause of death in women between six weeks and a year of their pregnancies ending, accounting for 18% of the women who died between 2018 and 2020.
- At least half of the women who died by suicide and the majority from substance misuse had multiple adversity with a history of childhood and/or adult trauma frequently reported.
- Cardiovascular disorders and psychiatric disorders are now equally responsible for maternal deaths in the UK, accounting for 30% of the women who died up to six weeks after the end of pregnancy; in previous reports, cardiovascular disorders have been reported as the leading direct cause of maternal death.
- 86% of the women died in the postnatal period.
The report demonstrates that even when the women who died as a result from COVID-19 are excluded, the number of women who died has still increased by 19% compared to 2017 – 2019, suggesting that an even greater focus on the report's recommendations for improvements to maternal healthcare are needed.
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