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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(05): 209-216
DOI: 10.1055/s-0037-1603498
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Skin Color and Maternal Near Miss: Exploring a Demographic and Health Survey in Brazil

Cor de pele e Near Miss materno: explorando um inquérito demográfico de saúde no Brasil
Karayna Gil Fernandes
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
2   Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil
,
Maria Helena Sousa
2   Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil
,
José Guilherme Cecatti
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

16 January 2017

14 March 2017

Publication Date:
22 May 2017 (online)

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Abstract

Purpose In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006.

Method A secondary analysis of the DHS database, a population-based cross-sectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated.

Results In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women.

Conclusion The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.

Resumo

Objetivo Estima-se que em 2013 tenham ocorrido 289.000 mortes maternas no mundo. Observou-se uma redução na razão de mortalidade materna em muitos países nas últimas décadas, e isso se deveu à identificação e tratamento precoce das complicações obstétricas, embora de forma não similar entre os diversos locais e populações. As mulheres negras, por exemplo, sempre estiveram mais sujeitas à ocorrência de mortalidade materna e de morbidade grave. Então, o objetivo desse estudo foi avaliar a cor da pele como fator preditor de Near Miss materno (NMM) em uma amostra de mulheres brasileiras entrevistadas na Pesquisa Nacional de Demografia e Saúde (PNDS) de 2006.

Método Análise secundária do banco de dados da PNDS, um estudo transversal de base populacional e com representatividade nacional, sendo este banco de dados de domínio público. Avaliou-se o risco de complicações maternas por grupo de cor da pele e as características sociodemográficas associadas. Para a análise dos dados, as razões de possibilidades e os respectivos intervalos de confiança de 95% foram calculados.

Resultados Na amostra entrevistada, 59% das mulheres eram negras ou pardas. Aproximadamente 23% das mulheres apresentaram alguma complicação, e 2% delas, pelo menos um critério pragmático de NMM. A taxa de NMM foi de 31 por 1.000 nascidos vivos, e sua ocorrência não foi estatisticamente diferente entre os grupos de cor da pele. Os únicos fatores identificados como associados à ocorrência de NMM foram a idade materna acima de 40 anos e não estar atualmente estudando, mas apenas entre as mulheres brancas.

Conclusão Os resultados da PNDS 2006 não mostraram uma maior ocorrência de complicações maternas e especificamente de NMM associadas à cor da pele negra/parda.

Keywords

severe maternal morbidity - maternal near miss - pregnancy complications - ethnicity - maternal and child health

Palavras-chave

morbidade materna grave - near miss materno - complicações da gestação - etnia - saúde materna e infantil
 

  • References

  • 1 World Health Organization [Internet]. Trends in maternal mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO; 2014 [cited 2015 Sep 8]. Available from: http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2013/en/
    PubMedGoogle Scholar
  • 2 Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynaecol Obstet 2005; 88 (02) 181-193
    CrossrefPubMedGoogle Scholar
  • 3 Say L, Souza JP, Pattinson RC. ; WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss--towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009; 23 (03) 287-296
    CrossrefPubMedGoogle Scholar
  • 4 Assari S. Number of chronic medical conditions fully mediates the effects of race on mortality; 25-year follow-up of a nationally representative sample of Americans. J Racial Ethn Health Disparities 2016 ; [Epub ahead of print]
    PubMedGoogle Scholar
  • 5 Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. ; UKOSS. Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities. BMJ 2009; 338: b542
    CrossrefPubMedGoogle Scholar
  • 6 Nair M, Kurinczuk JJ, Knight M. Ethnic variations in severe maternal morbidity in the UK- a case control study. PLoS One 2014; 9 (04) e95086
    CrossrefPubMedGoogle Scholar
  • 7 Martins AL. [Maternal mortality among black women in Brazil]. Cad Saude Publica 2006; 22 (11) 2473-2479
    CrossrefPubMedGoogle Scholar
  • 8 Caughey AB, Stotland NE, Washington AE, Escobar GJ. Maternal ethnicity, paternal ethnicity, and parental ethnic discordance: predictors of preeclampsia. Obstet Gynecol 2005; 106 (01) 156-161
    CrossrefPubMedGoogle Scholar
  • 9 Tucker MJ, Berg CJ, Callaghan WM, Hsia J. The Black-White disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. Am J Public Health 2007; 97 (02) 247-251
    CrossrefPubMedGoogle Scholar
  • 10 Brasil. Ministério da Saúde. Centro Brasileiro de Análise e Planejamento [Internet]. [National Research on Demography and Health of Child and Woman: PNDS 2006]. Brasília (DF): 2009 [cited 2016 Jul 28]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf . Portuguese
    PubMedGoogle Scholar
  • 11 Souza JP, Cecatti JG, Pacagnella RC. , et al. Development and validation of a questionnaire to identify severe maternal morbidity in epidemiological surveys. Reprod Health 2010; 7: 16
    CrossrefPubMedGoogle Scholar
  • 12 Souza JP, Parpinelli MA, Amaral E, Cecatti JG. Population surveys using validated questionnaires provided useful information on the prevalence of maternal morbidities. J Clin Epidemiol 2008; 61 (02) 169-176
    CrossrefPubMedGoogle Scholar
  • 13 Souza JP, Cecatti JG, Faundes A. , et al; World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health. Bull World Health Organ 2010; 88 (02) 113-119
    CrossrefPubMedGoogle Scholar
  • 14 Dias MA, Domingues RM, Schilithz AO. , et al. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study. Cad Saude Publica 2014; 30 (Suppl. 01) S1-S12
    CrossrefPubMedGoogle Scholar
  • 15 Instituto Brasileiro de Geografia e Estatística [Internet]. Distribuição espacial da população segundo cor ou raça - pretos e pardos. 2010 [citado 2015 Mar 27]. Disponível em: ftp://geoftp.ibge.gov.br/cartas_e_mapas/mapas_do_brasil/sociedade_e_economia/mapas_murais/brasil_pretos_pardos_2010.pdf
    PubMedGoogle Scholar
  • 16 Domingues RM, Dias MA, Schilithz AO, Leal MD. Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011-2012. Reprod Health 2016; 13 (Suppl. 03) 115
    CrossrefPubMedGoogle Scholar
  • 17 Zamora-Kapoor A, Nelson LA, Buchwald DS, Walker LR, Mueller BA. Pre-eclampsia in American Indians/Alaska natives and whites: the significance of body mass index. Matern Child Health J 2016; 20 (11) 2233-2238
    CrossrefPubMedGoogle Scholar
  • 18 Zwart JJ, Jonkers MD, Richters A. , et al. Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands. Eur J Public Health 2011; 21 (02) 229-234
    CrossrefPubMedGoogle Scholar
  • 19 Howell EA, Egorova N, Balbierz A, Zeitlin J, Hebert PL. Black-white differences in severe maternal morbidity and site of care. Am J Obstet Gynecol 2016; 214 (01) 122.e1-122.e7
    CrossrefPubMedGoogle Scholar
  • 20 Grobman WA, Bailit JL, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol 2015; 125 (06) 1460-1467
    CrossrefPubMedGoogle Scholar
  • 21 Louis JM, Menard MK, Gee RE. Racial and ethnic disparities in maternal morbidity and mortality. Obstet Gynecol 2015; 125 (03) 690-694
    CrossrefPubMedGoogle Scholar