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