There has been an increase in the number of women dying during pregnancy or in the six weeks after the end of pregnancy in the UK, according to a new report produced by researchers from the National Perinatal Epidemiology Unit at the University of Oxford.
The report, Saving Lives, Improving Mothers’ Care, shows that 225 women died from direct and indirect causes during 2014-20161 (9.8 women for every 100,000 women giving birth). This compares to 202 in 2013-15 (8.8 per 100,000).
The analysis, produced for the latest MBRRACE-UK (Mothers and Babies – Reducing Risk through Audits and Confidential Enquiries across the UK) Confidential Enquiry into Maternal Deaths and Morbidity2, also shows major differences amongst ethnic groups – black women are five times more likely and Asian women two times more likely to die than white women.
Older women are also at higher risk – women who are aged 40 or over have three times the risk of dying during or after pregnancy compared to women in their early 20s.
The report examined the care of women who died by suicide or other mental health conditions, blood clots or cancer, or who were murdered.3 The care of women who survived severe bleeding was also reviewed. The authors emphasise the importance of considering the benefits of starting or continuing medications to treat physical and mental health conditions during pregnancy, as well as the risks. Many medicines are safe in pregnancy, and so ensuring a mother remains properly treated while she is pregnant may be the best way to care for her baby.
The researchers also highlight the risk of blood clots particularly amongst women who are overweight and obese, and urge women to be aware of the symptoms of possible blood clots – leg or buttock pain and breathlessness – even in very early pregnancy. Preventive blood-thinning injections or tablets may be needed.
Although cancer in pregnancy is uncommon, the authors note that both women and their doctors and midwives need to be aware that it can happen. Many symptoms in pregnancy are normal, but there is a need for better recognition of symptoms that are abnormal – such as severe or recurrent pain.
‘Women and their families should be reassured that the number of women dying as a consequence of complications during or after pregnancy remains low in the UK. However, preventive treatments such as vaccination, or continuing medication in pregnancy, may be essential to keep healthy, particularly for women with known physical and mental health conditions,’ said Marian Knight, Professor of Maternal and Child Population Health at the National Perinatal Epidemiology Unit, Nuffield Department of Population Health, who led the study.
‘There are many normal physical and mental changes in pregnancy, but being ‘body aware’ and seeking specialist advice about unusual or persistent symptoms is important’, she added.
Professor Jennifer Kurinczuk, Director of the National Perinatal Epidemiology Unit at the Nuffield Department of Population Health and national lead for MBRRACE-UK said: ‘In this report we make a number of recommendations to improve care, and we urge health professionals, managers and those who plan services to put these into action. They are essential to prevent deaths and to meet the Government ambition of a 50% reduction in the number of women dying as a consequence of pregnancy complications by 2025.’
Professor Knight added: ‘The disparity in mortality rates between women from different ethnic groups is of particular concern. We know that women from some ethnic groups have more pre-existing conditions, but further research is urgently needed to fully explain why more black and Asian women die and to develop actions to prevent women from dying in the future.’
The report, executive summary, lay summary and infographic are available here.