{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:36:12Z","timestamp":1790703372094,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,3,10]],"date-time":"2016-03-10T00:00:00Z","timestamp":1457568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Unmatched case\u2013control analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>All hospitals caring for pregnant women in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Comprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>) and 1516 women who did not have any life\u2010threatening complications during pregnancy and childbirth (controls) obtained from <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> Obstetric Surveillance System (<jats:styled-content style=\"fixed-case\">UKOSS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Odds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [<jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content>], early neonatal death) and incremental risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven factors, of 13 examined, were independently associated with increased odds of maternal death: pre\u2010existing medical comorbidities (adjusted odds ratio [<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>] 8.65; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 6.29\u201311.90), anaemia during pregnancy (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 3.58; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.14\u201311.21), previous pregnancy problems (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.85; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.33\u20132.57), inadequate use of antenatal care (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 46.85; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 19.61\u2013111.94), substance misuse (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 12.21; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.33\u201363.98), unemployment (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.81; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.08\u20133.04) and maternal age (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.06; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.04\u20131.09). There was a four\u2010fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to <jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content> and early neonatal death were higher among women who died.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010economic inequalities in maternal death in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Medical comorbidities and socio\u2010economic inequalities are important risk factors for maternal death in the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13978","type":"journal-article","created":{"date-parts":[[2016,3,12]],"date-time":"2016-03-12T07:17:21Z","timestamp":1457767041000},"page":"1654-1662","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Risk factors and newborn outcomes associated with maternal deaths in the <scp>UK<\/scp> from 2009 to 2013: a national case\u2013control study"],"prefix":"10.1111","volume":"123","author":[{"given":"M","family":"Nair","sequence":"first","affiliation":[{"name":"National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JJ","family":"Kurinczuk","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0029077"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13279"},{"key":"e_1_2_6_4_1","volume-title":"Antenatal Care [CG62]","author":"National Institute for Health and Care Excellence","year":"2008"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-12-S1-S4"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001409"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-12-S1-S7"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2006.10.010"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12633"},{"key":"e_1_2_6_10_1","volume-title":"Perinatal Mortality Surveillance Report UK Perinatal Deaths for Births from January to December 2013","author":"Manktelow BM","year":"2015"},{"key":"e_1_2_6_11_1","unstructured":"National Records of Scotland.Vital events reference tables 2013. 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