The MBRRACE-UK collaboration, led by NDPH’s National Perinatal Epidemiology Unit (NPEU), has today issued its latest report Saving Lives, Improving Mothers’ Care. This continues the work of the Confidential Enquiries into Maternal Deaths and Morbidity programme, which examines the care received by women who die during or up to a year after pregnancy. The current report covers all pregnancy-associated deaths involving UK women between 2016 and 2018. The results indicate that whilst maternal death is still rare in the UK, there are some important actions identified to prevent women from dying in the future.
- Pregnancy remains very safe in the UK. In 2016-18, 2,235,159 women gave birth in the UK of which 547 died during or up to a year after pregnancy from causes associated with their pregnancy.
- Heart disease remains the leading cause of death, followed by thrombosis and thromboembolism (blood clots). Maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, and is the leading cause of death over the first year after pregnancy.
- The number of deaths from Sudden Unexpected Death in Epilepsy (SUDEP) almost doubled compared with the previous three years. Most women who died had clear risk factors for SUDEP, but had not had prevention measures discussed with them, or a medication review.
- Almost all (90%) of the women who died had multiple problems such as a mental or physical health diagnosis, older age, domestic abuse, living in a deprived area, or unemployment. More than half of the women who died were overweight or obese.
- Outcomes for women were not equal, with significant differences in mortality rates between women from different areas and women of different ages. For instance, women living in the most deprived areas were almost three times more likely to die than those who lived in the most affluent areas.
- Maternal death rates were almost four times higher for women from Black ethnic backgrounds and almost two times higher for women from Asian ethnic backgrounds, compared to white women.
The recommendations from the report include:
- Women who have epilepsy and are considering pregnancy should discuss this with their epilepsy team, and have a full review of their medication. Epilepsy medications should not be stopped simply because of pregnancy.
- All healthcare professionals should be aware that pregnant women with epilepsy are at greater risk. ‘Red flags’ for SUDEP (such as night-time seizures) should be widely known and immediately acted on. There should be rapid referral pathways in place between maternity units and epilepsy teams experienced in treating pregnant women.
- Healthcare providers should offer models of care tailored for different groups of women, taking into account their preferences and values. Women who are not native English speakers should be provided with interpreters who can communicate with them in their preferred language.
- Many of the complex factors underlying women’s increased risk need action more widely than in maternity services, and beyond the health sector, and often long before pregnancy. Wider system actions are needed in order to reduce deaths of women during or after pregnancy, as well as their babies, and the learning from this report applies not only to maternity staff, but more widely to GPs, emergency department practitioners, physicians and surgeons.
Professor Marian Knight (NPEU), who led the study, said ‘It is now recognised that disparity in maternal mortality simply because of a woman’s ethnicity is unacceptable. It is equally unacceptable for women with pre-existing medical conditions such as epilepsy to receive a lower standard of care simply because they are pregnant. Systemic biases prevent women with complex and multiple problems receiving the care they need. This needs to be addressed urgently, particularly since the impacts of social and ethnic inequalities, multiple disadvantage and epilepsy, are likely to have been amplified during the COVID-19 pandemic.’
Read the report on the NPEU website.