法国巴黎城市大学Catherine Deneux-Tharaux团队研究了有加强监测系统的八个欧洲国家的产妇死亡率。该研究于2022年11月16日发表在《英国医学杂志》上。

为了比较八个国家加强监测系统的孕产妇死亡率，研究组进行了一项基于人口的描述性多国研究。八个国家拥有永久性监测系统，使用增强的方法来识别、记录和审查孕产妇死亡。法国、意大利和英国收集了三年期，丹麦、芬兰、荷兰、挪威和斯洛伐克收集了五年期的最新汇总孕产妇死亡率数据。

丹麦（2013-17年）共有297835例活产，芬兰（2008-12年）301169例，法国（2013-15年）2435583例，意大利（2013-15）1281986例，荷兰（2014-18年）856572例，挪威（2014-18）292315例，斯洛伐克（2014-18日）283930例，英国（2016-18年）2261090例。

研究组计算了来自增强系统的孕产妇死亡率，并将其与各国人口统计局的数据进行了比较。还评估了特定年龄产妇死亡率；根据妇女出身、公民身份或族裔的孕产妇死亡率；并计算了特定原因的孕产妇死亡率。

各国（荷兰除外）对42天以内孕产妇死亡的识别和分类方法非常相似。妊娠结束后42天内的孕产妇死亡率从挪威和丹麦每10万活产2.7例和3.4例，到英国和斯洛伐克的9.6例和10.9例不等，相差4倍。除丹麦外，各地的人口统计局低估了36%或更多的孕产妇死亡率。

最年轻和最年长母亲的特定年龄孕产妇死亡率更高（与20-29岁的女性相比，20岁以下妇女的合并相对风险为2.17，35-39岁妇女的平均相对风险为2.10，≥40岁妇女为3.95）。除挪威外，出生在国外或少数民族的女性孕产妇死亡率高出50%，这在不同国家有不同的定义。

心血管疾病和自杀是每个国家孕产妇死亡的主要原因。只有一到两个国家的其他一些情况也是导致产妇死亡的主要原因：英国和荷兰的静脉血栓栓塞、荷兰的高血压疾病、法国的羊水栓塞、意大利的出血和斯洛伐克的中风。只有法国和英国加强了研究晚期孕产妇死亡的方法，这些死亡发生在妊娠结束后43至365天之间。

研究结果表明，监测系统加强的高收入欧洲国家之间的孕产妇死亡率存在差异。需要深入分析国家一级护理质量和卫生系统绩效的差异，通过学习最佳做法和相互学习，进一步降低孕产妇死亡率。所有国家都必须优先考虑怀孕期间和怀孕后妇女的心血管疾病和心理健康。

附：英文原文

Title: Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study

Author: Caroline Diguisto, Monica Saucedo, Athanasios Kallianidis, Kitty Bloemenkamp, Birgit Bdker, Marta Buoncristiano, Serena Donati, Mika Gissler, Marianne Johansen, Marian Knight, Miroslav Korbel, Alexandra Kristufkova, Lill T Nyflot, Catherine Deneux-Tharaux

Issue&Volume: 2022/11/16

Abstract:

Objective To compare maternal mortality in eight countries with enhanced surveillance systems.

Design Descriptive multicountry population based study.

Setting Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia.

Population 297835 live births in Denmark (2013-17), 301169 in Finland (2008-12), 2435583 in France (2013-15), 1281986 in Italy (2013-15), 856572 in the Netherlands (2014-18), 292315 in Norway (2014-18), 283930 in Slovakia (2014-18), and 2261090 in the UK (2016-18).

Outcome measures Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country’s office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women’s origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated.

Results Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy.

Conclusions Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.

DOI: 10.1136/bmj-2022-070621

Source: https://www.bmj.com/content/379/bmj-2022-070621