title: Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case-control study.
abstract: OBJECTIVE
  To identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK.
  
  
  METHODS
  Unmatched case-control analysis.
  
  
  METHODS
  All hospitals caring for pregnant women in the UK.
  
  
  METHODS
  Comprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life-threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS).
  
  
  METHODS
  Multivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.
  
  
  RESULTS
  Odds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk.
  
  
  RESULTS
  Seven factors, of 13 examined, were independently associated with increased odds of maternal death: pre-existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29-11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14-11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33-2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61-111.94), substance misuse (aOR 12.21; 95% CI 2.33-63.98), unemployment (aOR 1.81; 95% CI 1.08-3.04) and maternal age (aOR 1.06; 95% CI 1.04-1.09). There was a four-fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died.
  
  
  CONCLUSIONS
  This study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio-economic inequalities in maternal death in the UK.
  
  
  CONCLUSIONS
  Medical comorbidities and socio-economic inequalities are important risk factors for maternal death in the UK.
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nair
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Knight
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kurinczuk
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008423:Maternal Age; D063130:Maternal Death / Q000706:statistics & numerical data*; D016017:Odds Ratio; D066087:Perinatal Death / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth; D006113:United Kingdom / Q000453:epidemiology
keywords: Early neonatal death; UK; maternal death; risk factors; stillbirth