Anthea Lindquist

Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study

Objectives This study aimed to explore the independent association between socioeconomic position, defined by occupation, and severe maternal morbidity among women in the UK. Design Case–control study. Setting The analysis was conducted as a case–control analysis, using data from a series of studies of direct causes of severe maternal morbidity undertaken through the UK Obstetric Surveillance System (UKOSS), with data collected throughout all consultant-let obstetric units in the UK. Participants The analysis included 1144 cases and 2256 comparison women (controls). UKOSS studies from which data on case women were obtained included amniotic fluid embolism, acute fatty liver of pregnancy, eclampsia, peripartum hysterectomy, therapies for peripartum haemorrhage and uterine rupture. Primary outcome measure Odds of severe maternal morbidity by socioeconomic group, independent of ethnicity, maternal age, smoking, pre-existing medical condition, body mass index (BMI), multiple pregnancy and past pregnancy complications. Occupation was used to classify different socioeconomic groups. Secondary outcome measure Odds of morbidity related to ethnic group, maternal age, smoking, pre-existing medical condition, BMI, multiple pregnancy and past pregnancy complications. Results Across the socioeconomic groups, compared with the ‘managerial/professional’ group, adjusted ORs were 1.17 (95% CI 0.94 to 1.45) for the ‘intermediate group’, 1.16 (95% CI 0.93 to 1.45) for ‘routine/manual’, 1.22 (95% CI 0.92 to 1.61) for ‘unemployed’ women and 1.51 (95% CI 1.18 to 1.94) for women with missing socioeconomic information. Women of non-white ethnicity, older maternal age (≥35 years), BMI ≥25 kg/m2 and those with pre-existing medical condition/s, multiple pregnancy or past pregnancy complications were shown to have a significantly increased odds of severe maternal morbidity. Conclusions This study suggests that socioeconomic position may be independently associated with an increased risk of severe maternal morbidity, although the observed association was not statistically significant. Further research is warranted to confirm this and investigate why this association might exist in a country where healthcare is universal and free at the point of access.

The UK Obstetric Surveillance System: impact on patient safety.

The UK Obstetric Surveillance System is a national system that allows for the collection of information on a range of rare disorders of pregnancy, enabling national descriptive, case-control and cohort studies. The population-based nature of the studies conducted renders them less susceptible to the biases typically associated with observational studies. Data collected using The UK Obstetric Surveillance System and similar systems can be used to address a range of patient safety issues. These include assessing the safety of different treatment options, using the data as an aid to service planning, as part of ongoing quality-improvement initiatives, as a benchmark against which to compare hospital-level disease incidence and outcomes, to inform and audit national guidelines, and to monitor the effect of changes in practice or policy. Studies can be introduced rapidly in response to newly arising safety concerns. International comparisons can further enhance the utility of these data for improving patient safety.

Experiences, utilisation and outcomes of maternity care in England among women from different socio‐economic groups: findings from the 2010 National Maternity Survey

The objective of this analysis was to explore the healthcare‐seeking behaviours and experiences of maternity care among women from different socio‐economic groups in order to improve understanding of why socially disadvantaged women have poorer maternal health outcomes in the UK.

Risk factors for maternal morbidity in Victoria, Australia: a population-based study.

Objectives The aim of this analysis was to quantify the risk factors associated with maternal morbidity among women in Victoria, Australia, focusing particularly on sociodemographic factors. Design Case–control analysis. Participants Data on all maternities in Victoria from 1 January 2006 to 31 December 2008. Methods A case–control analysis was conducted using unconditional logistic regression to calculate adjusted ORs (aORs). Cases were defined as all women noted to have had a severe complication during the index pregnancy. Severe maternal morbidity was defined by the validated, composite Australian Maternal Morbidity Outcome Indicator. Socioeconomic position was defined by Socio-Economic Indices for Areas (SEIFA), specifically the Index of Relative Socioeconomic Disadvantage (IRSD), and other variables analysed were age, parity, Indigenous background, multiple pregnancy, country of birth, coexisting medical condition, previous caesarean section, spontaneous abortion or ectopic pregnancy. Results The study population comprised 211 060 women, including 1119 cases of severe maternal morbidity (0.53%). Compared with the highest IRSD quintile, the aOR for the 2nd quintile was 1.23 (95% CI 1.03 to 1.49), 0.98 (95% CI 0.79 to 1.21) for the 3rd quintile, 1.55 (95% CI 1.28 to 1.87) for the 4th and 1.21 (95% CI 1.00 to 1.47) for the lowest (most deprived) quintile. Indigenous status was associated with twice (aOR 2.02; 95% CI 1.32 to 3.09) the odds of being a case. Other risk factors for severe maternal morbidity were age ≥35 years (aOR 1.22; 95% CI 1.04 to 1.44), coexisting medical condition (aOR 1.39; 95% CI 1.16 to 1.65), multiple pregnancy (aOR 2.30; 95% CI 1.71 to 3.10), primiparity (aOR 1.36; 95% CI 1.18 to 1.57), previous caesarean section (aOR 1.79; 95% CI 1.53 to 2.10) and previous spontaneous miscarriage (aOR 1.25; 95% CI 1.08 to 1.44). Conclusions The findings from Victoria strongly suggest that social disadvantage needs to be acknowledged and further investigated as an independent risk factor for adverse maternal outcomes in Australia and incorporated into appropriate policy planning and healthcare programmes.