More mothers are dying from causes related to obesityBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39420.350799.DB (Published 06 December 2007) Cite this as: BMJ 2007;335:1175
Deaths from cardiac causes, often linked to obesity, are now the commonest type of death among women during pregnancy and childbirth, finds the latest three year report into why mothers die in pregnancy and childbirth in the United Kingdom.
The report from the Confidential Enquiry into Maternal and Child Health, covering 2003-5, reports a shift from the last report, which found that suicide was the leading cause of overall mortality. The number of suicides fell from 58 in 2000-2 to 37 in 2003-5.
Deaths from acquired ischaemic and other acquired cardiac disease accounted for 44 of all the 48 deaths from cardiac causes (91%), up from 35 out of 44 cardiac deaths (79%) in the last report, said Gwyneth Lewis, director of the inquiry. The number of deaths from congenital heart disease fell from nine (20% of all cardiac deaths) in 2000-2 to four (8%) in 2003-5.
“Most cardiac deaths are completely and utterly associated with lifestyle. It is a big finding,” she said.
Of direct causes, thromboembolism is top. Both this cause and cardiac disease are linked to obesity, Dr Lewis said. “Fifty two per cent of mothers who had booked for antenatal care who died were overweight or obese,” she said, “in comparison to estimates of 10-11% in the general population.
“Some women had arms so big that the standard blood pressure cuff would not go round.”
However, death during pregnancy or within 42 days of delivery continues to be rare in the UK, the report says, with only 295 women dying out of two million mothers who gave birth in the three year period. The overall maternal death rate in 2003-5 was 14 per 100 000 (whether the death was directly or indirectly related to the pregnancy), a figure not significantly different from that in the previous report.
A rise in the number of women from overseas giving birth in the UK has had an effect on maternal mortality, the report shows. New immigrants, refugees, asylum seekers, and “health tourists” may have more complicated pregnancies, poorer health, and more serious underlying medical conditions than mothers born in the UK, it says. Language and cultural barriers also mean that they are more likely to have problems accessing maternity care.
Maternal mortality among black African women was six times that among white women, it found; and for the first time the report picked up several maternal deaths among women from the new member states of the European Union.
Although the number of women aged over 35 who became mothers has more than doubled since the first report in 1985-7, early access to care and longer stays in care have meant that mortality in this group has fallen a little, said Dr Lewis.
The report found no increase in substandard care, but it criticised clinical teams for failing to identify and manage common medical conditions outside their area of expertise.
One particular concern was emergency medicine; and for the first time the report included a chapter specifically on emergency care practitioners. The report noted that 52 women (18% of the total who died) who died from direct, indirect, or coincidental causes died in an emergency department in 2003-5. In cases where the care provided in emergency departments was found to be linked to the deaths, poor clinical practice concerning recognition of serious illness and diagnosis of pulmonary embolism, tachycardia, and ectopic pregnancy were an issue, the report says. It calls for further training and education of staff and better service provision, along with better availability of senior doctors when patients collapse or are very unwell.
The report also recommends:
Better preconception care, especially for women with pre-existing medical conditions
Thorough assessment of the health of immigrant women, and
An early warning scoring system to help trusts recognise and refer women who may be developing critical conditions.
It also says that guidelines are needed from the National Institute for Health and Clinical Excellence on the care of obese women and those with infections during pregnancy and on pain and bleeding in early pregnancy
James Neilson, head of the School of Reproduction at the University of Liverpool, said, “There is a problem with individual clinicians not being suspicious that an individual might have an ectopic pregnancy. It is a problem in primary care and in emergency departments, where misdiagnosis is happening, particularly in women with atypical presentations such as vomiting and diarrhoea.”
Saving Mothers’ Lives: The 7th Confidential Enquiry into Maternal and Child Health can be found at www.cemach.org.uk.