Analysis of maternal mortality in Berlin, Germany - discrepancy between reported maternal mortality and comprehensive death certificate exploration.
MMR
maternal mortality
maternal mortality registry
public health
underreporting of maternal deaths
Journal
Journal of perinatal medicine
ISSN: 1619-3997
Titre abrégé: J Perinat Med
Pays: Germany
ID NLM: 0361031
Informations de publication
Date de publication:
19 Dec 2023
19 Dec 2023
Historique:
received:
26
09
2023
accepted:
11
11
2023
medline:
18
12
2023
pubmed:
18
12
2023
entrez:
18
12
2023
Statut:
aheadofprint
Résumé
The OECD estimates an average maternal mortality rate (MMR) of around 3.4 maternal deaths per 100,000 live births for 2019-2021, based on relevant diagnoses on death certificates. However, Germany does not currently have a registry for recording the number of maternal deaths. The aim of this study is to identify the actual number of maternal deaths in Berlin between 2019 and 2022, as well as sources of underreporting and causes of death. Potential maternal mortality cases were identified through a search at the Berlin Central Archive for Death Certificates, inquiring women aged 15-50 years with indications of present or recent pregnancy on the death certificate. To cross match the database, an additional search at the Charité University Hospital Berlin was carried out, checking each individual file for pregnancy-association. The data search resulted in 2,316 women, 18 of which presented an association to pregnancy. Of these, 12 could be classified as maternal mortality cases (MMR 7.8/100,000). The additional search in a university setting revealed two further maternal mortality cases without prior indication of pregnancy on the death certificate. This results in a total MMR of 9.1/100,000 live births, which is over double the official estimate by the OECD. Based on our findings in Berlin, it can be estimated that there is significant underreporting regarding maternal death cases in Germany. A more comprehensive recording system is needed to more accurately portray maternal mortality.
Identifiants
pubmed: 38109281
pii: jpm-2023-0403
doi: 10.1515/jpm-2023-0403
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Walter de Gruyter GmbH, Berlin/Boston.
Références
WHO . Maternal deaths: World Health Organization [Online] . https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622 [Accessed 19 Sep 2023].
CDC . Pregnancy mortality surveillance system [Online] . https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm [Accessed 19 Sep 2023].
Bailey, E. More action needed to reduce global maternal mortality [Online] . https://blogs.bmj.com/ebn/2023/04/09/more-action-needed-to-reduce-global-maternal-mortality/ [Accessed 19 Sep 2023].
WHO . Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division . Geneva: World Health Organization; 2023. Report No. 978 92 4 006875 9.
UN . Millennium Summit, 6-8 September 2000, New York [Online] . https://www.un.org/en/conferences/environment/newyork2000 [Accessed 19 Sep 2023].
UN . SDG indicators: regional groupings used in report and statistical annex [Online] . https://unstats.un.org/sdgs/indicators/regional-groups/ [Accessed 19 Sep 2023].
WHO . Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer [Online] . https://iris.who.int/handle/10665/42984 [Accessed 19 Sep 2023].
Bamber, JH, Kinsella, SM. MBRRACE-UK – the new home for the confidential enquiries into maternal deaths – reports for the first time. Anaesthesia 2015;70:5–9, https://doi.org/10.1111/anae.12938 .
doi: 10.1111/anae.12938
OECD . OECD health statistics 2023 [Online] . https://www.oecd.org/health/health-data.htm [Accessed 19 Sep 2023].
Senatsverwaltung für Justiz- und Verbraucherschutz: Gesetz- und Verordnungsblatt, Art.-Nr. 76491420, 70. Jahrgang Nr. 20 , 13 Aug 2014.
Lin, CY, Tsai, PY, Wang, LY, Chen, G, Kuo, PL, Lee, MC, et al.. Changes in the number and causes of maternal deaths after the introduction of pregnancy checkbox on the death certificate in Taiwan. Taiwan J Obstet Gynecol 2019;58:680–3, https://doi.org/10.1016/j.tjog.2019.07.017 .
doi: 10.1016/j.tjog.2019.07.017
Davis, NL, Hoyert, DL, Goodman, DA, Hirai, AH, Callaghan, WM. Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978-2012. Am J Obstet Gynecol 2017;217:352.e1–7, https://doi.org/10.1016/j.ajog.2017.04.042 .
doi: 10.1016/j.ajog.2017.04.042
Diguisto, C, Saucedo, M, Kallianidis, A, Bloemenkamp, K, Bødker, B, Buoncristiano, M, et al.. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ 2022;379:e070621, https://doi.org/10.1136/bmj-2022-070621 .
doi: 10.1136/bmj-2022-070621
Hellmeyer, L, Zinn-Kirchner, Z, Königbauer, JT. Maternal mortality in the city of Berlin: consequences for perinatal healthcare. J Perinat Med 2023;51:182–7, https://doi.org/10.1515/jpm-2021-0604 .
doi: 10.1515/jpm-2021-0604
WHO . The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM . Geneva: World Health Organization; 2012.
Amt für Statistik Berlin-Brandenburg . Statistischer Bericht A II 1 – j/ 22 Eheschließungen, Geborene und Gestorbene in Berlin 2022 . Potsdam: Amt für Statistik Berlin-Brandenburg; 2023.
IQTIG . Qualitätsreport 2020 . Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2020.
IQTIG . Rückmeldebericht für den Leistungserbringer Perinatalmedizin: Geburtshilfe Erfassungsjahr 2022 Standort: be+lkg#gem15mh6prau . Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2023.
Charité . Jahresbericht 2019 [Online] . https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2019.pdf [Accessed 23 Sep 2023].
Charité . Jahresbericht 2020 [Online] . https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2020.pdf [Accessed 23 Sep 2023].
Charité . Jahresbericht 2021 [Online] . https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2021.pdf [Accessed 23 Sep 2023].
Charité . Jahresbericht 2022 [Online] . https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2022_DE.pdf [Accessed 23 Sep 2023].
IQTIG . Jahresauswertung 2019 Geburtshilfe 16/1 Charité – Universitätsmedizin Berlin Klinik für Geburtsmedizin und Berlin Gesamt . Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2020.
Knight, M, Bunch, K, Patel, R, Shakespeare, J, Kotnis, R, Kenyon, S, et al.. Saving lives, improving mothers’ care core report – lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018-20 . Oxford: University of Oxford, National Perinatal Epidemiology Unit; 2022.
Chmielewska, B, Barratt, I, Townsend, R, Kalafat, E, van der Meulen, J, Gurol-Urganci, I, et al.. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021;9:e759–2, https://doi.org/10.1016/s2214-109x(21)00079-6 .
doi: 10.1016/s2214-109x(21)00079-6
Villar, J, Ariff, S, Gunier, RB, Thiruvengadam, R, Rauch, S, Kholin, A, et al.. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021;175:817–26, https://doi.org/10.1001/jamapediatrics.2021.1050 .
doi: 10.1001/jamapediatrics.2021.1050
Calvert, C, John, J, Nzvere, FP, Cresswell, JA, Fawcus, S, Fottrell, E, et al.. Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review. Glob Health Action 2021;14:1974677, https://doi.org/10.1080/16549716.2021.1974677 .
doi: 10.1080/16549716.2021.1974677
Robert-Koch-Institut . 7-Tage-Inzidenz der COVID-19-Fälle in Deutschland Berlin [Online] . https://zenodo.org/record/8336801 [Accessed 19 Sep 2023].
MacDorman, MF, Declercq, E. The failure of United States maternal mortality reporting and its impact on women’s lives. Birth 2018;45:105–8, https://doi.org/10.1111/birt.12333 .
doi: 10.1111/birt.12333