The leading cause of maternal deaths in the UK is still cardiovascular disease, including heart attacks, heart failure and heart rhythm problems, and there has been no reduction in maternal cardiovascular mortality rates for more than 15 years.
These are the main findings of a new report, Saving Lives, Improving Mothers’ Care, from the National Perinatal Epidemiology Unit (NPEU), part of the Nuffield Department of Population Health (NDPH) at the University of Oxford.
The report is the latest produced for the Maternal, Newborn and Infant Clinical Outcome Review Programme, run by the MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) collaboration. The authors analysed 2.3m pregnancies from 2015-2017 in the UK and Ireland. During that three-year period, 209 women in the UK and Ireland died during their pregnancies or up to six weeks afterwards from pregnancy-related causes. This is equivalent to just over nine women per 100,000.
Of the women who died, 48, or 23%, died from heart disease, while 16% died from blood clots. A further 13% of women’s deaths were caused by epilepsy and stroke.
When the deaths were reviewed, the researchers found that many of the women who died from cardiovascular disease had classic symptoms that would have been flagged in a non-pregnant person, but instead were put down to their pregnancy. Three quarters of the women who died did not know they had heart disease before they became pregnant.
The researchers encourage women to be aware of the risks and symptoms of cardiovascular disease, such as chest pain or a racing heart, and make healthcare professionals aware of cardiovascular disease, or a history of sudden unexplained deaths, in their families. Healthcare professionals should follow recent guidelines on managing cardiovascular disease in pregnancy issued by the European Society of Cardiology.
Other causes of maternal deaths up to six weeks after pregnancy include sepsis (10%), mental health conditions (10%) and cancer (4%). Mental health conditions remain the leading cause of pregnancy-associated deaths between six weeks and a year postnatally (30%).
The report also found similar racial inequalities to those noted in previous reports. Black women are five times more likely to die as a result of pregnancy than white women. Women with mixed ethnicity are three times as likely to die as white women and Asian women twice as likely to die. Investigations are ongoing to determine the underlying causes of the disparity and how to tackle it.
The researchers are keen to reassure women that pregnancy remains very safe in the UK and Ireland, and the number of women who die during or after pregnancy is very small.
Marian Knight, Professor of Maternal and Child Population Health at the National Perinatal Epidemiology Unit, who led the study, said ‘Pregnancy places additional strain on the heart and it is important for women and their families to be aware that they may experience symptoms of heart disease for the first time during or after pregnancy. Pregnant or postnatal women should seek urgent advice from their doctor or midwife if they have chest pain which spreads to the back, neck or arm, severe breathlessness or a constantly racing heart.’
Professor Jennifer Kurinczuk, Director of the National Perinatal Epidemiology Unit and national lead for MBRRACE-UK said: ‘Whilst this report shows that maternal death is still uncommon in the UK, women can and do get heart disease while pregnant or after they have had a baby. Women and families as well as health professionals need to be alert to concerning symptoms.’
The report additionally looks at improving the wider care of pregnant women, including those with a risk of pre-eclampsia, breast cancer, mental health conditions and early pregnancy disorders such as ectopic pregnancy.