Key result
Among women with severe maternal morbidity, Indigenous Māori ethnicity was associated with a higher rate of adverse fetal/neonatal outcomes compared to New Zealand European ethnicity (RR 1.30; 95% CI 1.04-1.64).
Why the study?
Despite global focus on severe maternal morbidity, less is known about its impact on fetal and neonatal outcomes.
What is the rate of adverse fetal and neonatal outcomes associated with severe maternal morbidity?
Cohort (n=400)
Yes
What is the rate of adverse fetal and neonatal outcomes associated with severe maternal morbidity?
Relative Risk: 1.3 (95% CI 1.04–1.64)
Absolute Event Rate: 63.7% vs 48.9%
Severe maternal morbidity is associated with high rates of adverse fetal and neonatal outcomes, with a disproportionate burden on Indigenous Māori women.
SMM linked to adverse fetal/neonatal outcomes in half of cases; leaves open whether ethnicity-targeted strategies improve equity.
BACKGROUND: While there is a global focus on severe maternal morbidity (SMM), less is known about the impact of SMM on fetal and neonatal outcomes. AIMS: To examine fetal/neonatal outcomes associated with SMM. MATERIALS AND METHODS: A national New Zealand (NZ) retrospective cohort study describing fetal/neonatal outcomes of all women with SMM admitted to a NZ Intensive Care Unit (ICU) or High Dependency Unit (HDU) in 2014. Adverse fetal/neonatal outcomes were defined as one or more of the following: fetal or early neonatal death, hypoxic ischaemic encephalopathy, Apgar score less than seven at five minutes, admission to Neonatal Intensive Care Unit or Special Care Baby Unit. RESULTS: There were 400 women with SMM admitted to NZ ICU/HDU units in 2014, and 395 (98.8%) had complete birth/pregnancy outcome information. Of these, 49.4% (195/395) were associated with an adverse fetal/neonatal outcome. Indigenous Māori women had a 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women (63.7% and 48.9% respectively; relative risk = 1.30, 95% CI 1.04-1.64). Pre-eclampsia was associated with an adverse fetal/neonatal outcome in 67% (81/120). Perinatal-related mortality rate was 53.1 per 1000 total births compared to NZ perinatal mortality of 11.2 per 1000 total births for 2014. CONCLUSION: SMM events are associated with high rates of adverse fetal/neonatal outcomes with a higher burden of adverse events for Māori. Further research is needed to explore opportunities in maternal and neonatal care pathways to improve fetal/neonatal outcomes and address inequities.
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Lawton et al. (2020) conducted a cohort in Severe maternal morbidity (n=400). Indigenous Māori ethnicity vs. New Zealand European ethnicity was evaluated on Adverse fetal/neonatal outcome (fetal/early neonatal death, hypoxic ischaemic encephalopathy, Apgar <7 at 5 mins, or NICU/SCBU admission) (RR 1.30, 95% CI 1.04-1.64). Among women with severe maternal morbidity, Indigenous Māori ethnicity was associated with a higher rate of adverse fetal/neonatal outcomes compared to New Zealand European ethnicity (RR 1.30; 95% CI 1.04-1.64).
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