{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T07:26:32Z","timestamp":1768548392048,"version":"3.49.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,6,3]],"date-time":"2018-06-03T00:00:00Z","timestamp":1527984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe trends in indirect cause\u2010specific pregnancy\u2010related mortality from 1998 to 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary analysis of annual, national cross\u2010sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women aged 10\u201350 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Jamaica, a middle\u2010income Caribbean country.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Maternal and late maternal deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Descriptive trend analyses of demographic and cause\u2010specific maternal and pregnancy\u2010related mortality ratios undertaken comparing the periods 1998\u20132003, 2004\u20132009 and 2010\u20132015. Multivariate logistic regression was used to confirm changes in risk of indirect death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Maternal, pregnancy\u2010related, direct, indirect and cause\u2010specific mortality ratios (deaths\/100 000 live births).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Maternal deaths from indirect conditions increased between the first two periods (<jats:italic>P<\/jats:italic> = 0.004) and stabilised in the third (<jats:italic>P<\/jats:italic> = 0.085). Associated with upward movement in cardiovascular deaths (<jats:italic>P<\/jats:italic><jats:sub>[trend]<\/jats:sub> = 0.003), women under 25 years were at elevated risk (odds ratio 1.44, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.00\u20132.08; <jats:italic>P<\/jats:italic> = 0.052). Haematological\/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (non\u2010communicable diseases, non\u2010obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 days versus 3 days) and more often died after the puerperium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Medical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality. Middle\u2010income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Postpuerperal medical services should be integrated into routine infant health services to improve continuity of care during this high\u2010risk period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Maternal survival (<jats:styled-content style=\"fixed-case\">SDG<\/jats:styled-content> 3.1) in <jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s requires better care for women with both non\u2010communicable diseases and obstetric conditions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15154","type":"journal-article","created":{"date-parts":[[2018,2,8]],"date-time":"2018-02-08T15:53:25Z","timestamp":1518105205000},"page":"1254-1261","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The evolving contribution of non\u2010communicable diseases to maternal mortality in Jamaica, 1998\u20132015: a population\u2010based study"],"prefix":"10.1111","volume":"125","author":[{"given":"AM","family":"McCaw\u2010Binns","sequence":"first","affiliation":[{"name":"Department of Community Health and Psychiatry University of the West Indies Mona Jamaica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LV","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Victoria Jubilee Hospital Ministry of Health Kingston Jamaica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SS","family":"Spence","sequence":"additional","affiliation":[{"name":"Family Health Unit Ministry of Health Kingston Jamaica"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1179\/136485906X97453"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2005.07.021"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7020.1600"},{"key":"e_1_2_6_5_1","first-page":"178","article-title":"Thirty\u2010five years of cardiac surgery in Jamaica","volume":"53","author":"Scarlett MD","year":"2004","journal-title":"West Indian Med J"},{"key":"e_1_2_6_6_1","unstructured":"STATIN.Population Census 2011. 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