Jahnavi Daru1, Javier Zamora2, Borja M Fernández-Félix3, Joshua Vogel4, Olufemi T Oladapo4, Naho Morisaki5, Özge Tunçalp4, Maria Regina Torloni6, Suneeta Mittal7, Kapila Jayaratne8, Pisake Lumbiganon9, Ganchimeg Togoobaatar10, Shakila Thangaratinam11, Khalid S Khan11. 1. Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK. Electronic address: j.daru@qmul.ac.uk. 2. Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK; CIBER Epidemiology and Public Health, Madrid, Spain. 3. CIBER Epidemiology and Public Health, Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain. 4. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland. 5. Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan. 6. Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil. 7. Department of Obstetrics & Gynecology, Fortis Memorial Research Institute, Gurgaon, India. 8. Family Health Bureau, Ministry of Health, Colombo, Sri Lanka. 9. Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 10. Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 11. Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK.
Abstract
BACKGROUND: Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. METHODS: We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. FINDINGS: 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). INTERPRETATION: Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. FUNDING: Barts and the London Charity. Copyright This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
BACKGROUND:Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. METHODS: We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. FINDINGS: 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). INTERPRETATION: Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. FUNDING: Barts and the London Charity. Copyright This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
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