Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.

<h4>Background</h4>Decreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population.<h4>Methods</h4>Demographic, servic...

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Autores principales:	Monika R Asnani, Affette M McCaw-Binns, Marvin E Reid
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3609c547d14149029182f3e9f22f641a
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spelling	oai:doaj.org-article:3609c547d14149029182f3e9f22f641a2021-11-18T07:35:53ZExcess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.1932-620310.1371/journal.pone.0026281https://doaj.org/article/3609c547d14149029182f3e9f22f641a2011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22039456/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Decreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population.<h4>Methods</h4>Demographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998-2002 and 2003-7.<h4>Results</h4>Women with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003-7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:<0.0001). The maternal mortality ratio for SCD decedents was 7-11 times higher than the general population, with 41% of deaths attributable to their disorder. Cause specific mortality was higher for cardiovascular complications, gestational hypertension and haemorrhage. Respiratory failure was the leading immediate cause of death.<h4>Conclusions</h4>Women with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines for managing SCD pregnancies and educating families with SCD.Monika R AsnaniAffette M McCaw-BinnsMarvin E ReidPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 10, p e26281 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Monika R Asnani Affette M McCaw-Binns Marvin E Reid Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
description	<h4>Background</h4>Decreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population.<h4>Methods</h4>Demographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998-2002 and 2003-7.<h4>Results</h4>Women with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003-7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:<0.0001). The maternal mortality ratio for SCD decedents was 7-11 times higher than the general population, with 41% of deaths attributable to their disorder. Cause specific mortality was higher for cardiovascular complications, gestational hypertension and haemorrhage. Respiratory failure was the leading immediate cause of death.<h4>Conclusions</h4>Women with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines for managing SCD pregnancies and educating families with SCD.
format	article
author	Monika R Asnani Affette M McCaw-Binns Marvin E Reid
author_facet	Monika R Asnani Affette M McCaw-Binns Marvin E Reid
author_sort	Monika R Asnani
title	Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
title_short	Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
title_full	Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
title_fullStr	Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
title_full_unstemmed	Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.
title_sort	excess risk of maternal death from sickle cell disease in jamaica: 1998-2007.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/3609c547d14149029182f3e9f22f641a
work_keys_str_mv	AT monikarasnani excessriskofmaternaldeathfromsicklecelldiseaseinjamaica19982007 AT affettemmccawbinns excessriskofmaternaldeathfromsicklecelldiseaseinjamaica19982007 AT marvinereid excessriskofmaternaldeathfromsicklecelldiseaseinjamaica19982007
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Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.

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