Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network

ABSTRACT

Background

The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging.

Objectives

To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities.

Methods

This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported.

Results

In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PR_adj 16.73, 95% CI [13.29–21.05]), being single (PR_adj 1.45, 95% CI [1.32–1.59]), maternal near miss or death (PR_adj 1.64, 95% CI [1.14–2.37]), preeclampsia (PR_adj 3.02, 95% CI [1.70–5.35]), eclampsia/HELPP (PR_adj 1.50, 95% CI [1.16–1.94]), maternal age (years) (PR_adj 1.01, 95% CI [<1.01–1.02]), major congenital anomalies (PR_adj 3.21, 95% CI [1.43–7.23]), diabetes (PR_adj 1.49, 95% CI [1.11–1.98]) and cardiac disease (PR_adj 1.65, 95% CI [1.14–2.37]).

Conclusion

Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

KEYWORDS:

• Neonatal morbidity
• neonatal mortality
• maternal morbidity
• maternal near miss
• Latin America

Responsible Editor Stig Wall

Responsible Editor Stig Wall

Acknowledgments

We thank all professionals who directly or indirectly participated in the data collection for this analysis and the PAHO-CLAP support for that. We also are grateful for the important input of Pablo Duran from PAHO-CLAP to the review of the manuscript.

Author contributions

The conceptual idea and plan for the analysis of this database came from some discussions between the CLAP staff (BM, CS, MC, LM, RGPL and SJS) and the University of Campinas staff (MLC, RTS, AGL and JGC). Data management and analysis were performed by RTS and MHS. The countries’ researchers (CMC, LMC, RL, GC, UR, ESH, WEA, RMG, CO, FG, RC, AS and AM) were responsible for data collection and quality control of data in each country. RTS wrote the first version of the manuscript which was then reviewed by all authors who contributed with important suggestions and agreed with the final version.

Disclosure statement

The authors declare they do not have competing interests. Authors who are staff members of the Pan American and World Health Organization are responsible for the views expressed in this publication. Their views do not necessarily represent the decisions or policies of the Pan American Health Organization.

Ethics approval and consent

The study was approved by the Research Ethics Committee (REC) of the Pan American Health Organization (PAHO) on 17 August 2018 (PAHOERC, under number: PAHO-2018-04-0025). The need for a consent form was waived by this ERC.

Paper context

We assessed the burden of maternal morbidity in neonatal outcomes in Latin American countries, representing an attempt to improve both maternal and neonatal health in the region. More than 87 thousand births from five countries were included with information from an electronic health information system containing perinatal data. With the increasing severity of maternal morbidity, there is a higher risk of poor neonatal outcomes, which can be used as routine monitoring for health status.

Data availability statement

The property of data used in this manuscript is of each participating country, coordinated by the PAHO-CLAP in Montevideo, Uruguay. The data can be available from there upon a reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2269736.

Additional information

Funding

There was not a specific fund for the study. The tool development, implementation, data collection in the countries’ facilities, data management and analysis were technically and financially supported by the PAHO-CLAP. Grant Number is N/A. Dr Renato T Souza received funding from the HRP Alliance, part of the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO), to complete his studies. This article represents the views of the named author only and does not represent the views of the World Health Organization.