Severe maternal morbidity (SMM) is a critical concern in obstetrics and public health, reflecting life-threatening conditions that women endure during pregnancy, childbirth, or postpartum. A comprehensive study published in the Journal of Obstetrics and Gynaecology Canada (JOGC) has cast a revealing light on the temporal trends and regional variations of SMM in Canada from 2003 to 2016.
This extensive research project, undertaken by a team of experts in maternal and infant health, harnessed data pertaining to hospital deliveries across Canada (excluding Québec) to delve into the changing patterns of SMM. The research findings, which hold significant implications for clinical practice and health policy, have been documented in JOGC with a DOI of 10.1016/j.jogc.2019.02.014.
The research study, led by Dr. Susie Dzakpasu from the Public Health Agency of Canada, covers a 14-year span of hospital delivery data, encompassing an impressively large study population of 3,882,790 deliveries. The team, including names such as Dr. Paromita Deb-Rinker, Dr. Laura Arbour, and Dr. Elizabeth K. Darling, utilized diagnosis and intervention codes to determine instances of SMM. Their work, which has been classified with a Canadian Task Force Classification of II-1, indicates significant fluctuations in SMM rates over time and illustrates stark disparities among the various regions studied.
Trends over Time
The article reveals an unsettling rise in severe hemorrhage rates, which escalated from 44.8 per 10,000 deliveries in 2003 to a peak of 62.4 per 10,000 in 2012. Fortunately, these rates observed a decline to 41.8 per 10,000 by 2016. Other conditions such as maternal intensive care unit admission and rates of sepsis witnessed a downward trend during the studied period.
Conversely, complications such as stroke, severe uterine rupture, hysterectomy, obstetric embolism, shock, and the requirement for assisted ventilation showcased an upward trend, signaling the need for targeted healthcare interventions to mitigate these risks. These findings are significant and relied on chi-square tests for trend to determine their statistical validity, ensuring robust and reliable research outcomes.
Regional Variations
The article provides a comparative analysis of SMM incidents across Canadian provinces and territories from 2012 to 2016. Alarmingly, certain areas reported higher composite SMM rates than the national average. Notably, Newfoundland and Labrador, Nova Scotia, New Brunswick, Manitoba, Saskatchewan, the Yukon, and Nunavut displayed elevated risk ratios—a fact that could be rooted in local healthcare infrastructures, socioeconomic conditions, or geographic isolation.
Lower rates of SMM were detected in Alberta and British Columbia, suggesting the potential benefit of examining and emulating successful healthcare practices from these regions. These regional comparisons underscore the varied landscape of maternal healthcare in Canada, drawing attention to the need for a tailored approach to address these disparities effectively.
This detailed surveillance report, representing contributions from researchers like Dr. Michael S. Kramer, Dr. Shiliang Liu, Dr. Wei Luo, and others, aligns with the effort to enhance maternal health practices across the country. By providing a nuanced understanding of the shifts in SMM over time and across regions, the study serves as a bedrock for informed decision-making in public health policy.
Impact and Future Directions
The JOGC report is not merely an academic document; it carries with it the potential to influence real-world outcomes for pregnant individuals and their families. By identifying areas that require critical health interventions, healthcare providers and policymakers can implement specific strategies aimed at reducing the incidence of severe complications during pregnancy and childbirth.
The research team, including accomplished academics such as Dr. Phil A. Murphy, Dr. Chantal Nelson, Dr. Heather Scott, and Dr. Michiel VandenHof, emphasizes the importance of ongoing surveillance. Continued monitoring is essential to ensure that interventions are effective and maternal health in Canada maintains an upward trajectory in safety and quality.
The collaborative effort, supported by the Canadian Perinatal Surveillance System (Public Health Agency of Canada), illustrates the vitality of a combined approach where experts from different regions and specialties unite towards a common goal: mitigating maternal health risks and promoting the well-being of mothers and their newborns.
Keywords
1. Severe Maternal Morbidity Canada
2. Canadian Maternal Health
3. Pregnancy Complications Trends
4. Regional Health Disparities
5. Obstetric Emergency Surveillance
References
1. Dzakpasu, S., Deb-Rinker, P., Arbour, L., Darling, E. K., Kramer, M. S., Liu, S., Luo, W., Murphy, P. A., Nelson, C., Ray, J. G., Scott, H., VandenHof, M., Joseph, K. S., & Canadian Perinatal Surveillance System (Public Health Agency of Canada). (2019). Severe Maternal Morbidity in Canada: Temporal Trends and Regional Variations, 2003-2016. Journal of Obstetrics and Gynaecology Canada, 41(11), 1589-1598.e16. https://doi.org/10.1016/j.jogc.2019.02.014
2. Callaghan, W. M., Creanga, A. A., & Kuklina, E. V. (2012). Severe Maternal Morbidity Among Delivery and Postpartum Hospitalizations in the United States. Obstetrics & Gynecology, 120(5), 1029-1036. https://doi.org/10.1097/AOG.0b013e31826d60c5
3. Geller, S. E., Koch, A. R., Garland, C. E., MacDonald, E. J., Storey, F., & Lawton, B. (2018). A Global View of Severe Maternal Morbidity: Moving Beyond Maternal Mortality. Reproductive Health, 15(Suppl 1), 98. https://doi.org/10.1186/s12978-018-0527-2
4. Joseph, K. S., Lisonkova, S., Muraca, G. M., Razaz, N., Sabr, Y., Mehrabadi, A., & Schisterman, E. F. (2017). Factors Underlying the Temporal Increase in Maternal Mortality in the United States. Obstetrics & Gynecology, 129(1), 91-100. https://doi.org/10.1097/AOG.0000000000001808
5. Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2017). Pregnancy-Related Mortality in the United States, 2006-2010. Obstetrics & Gynecology, 125(1), 5-12. https://doi.org/10.1097/AOG.0000000000001231