During the period 2016–2018 in France, the Inserm research group on perinatal and pediatric obstetric epidemiology (EPOPé), with the support of the French Ministry of Health, identified 272 cases of maternal deaths.
This seventh edition is based on data Confidential National Inquiry into Maternal Mortality (ENCMM) and covers the three-year period 2016–2018.
This amounts to about 90 deaths annually, or one death every four days in France, from causes related to pregnancy, childbirth or their consequences.
This number of 272 women who died corresponds to a maternal mortality ratio (MMR) of 11.8 deaths within one year of the end of pregnancy.
Cardiovascular causes versus obstetric hemorrhage
If maternal mortality rates remain unchanged from previous years, a notable result will be the predominance of suicide and psychiatric causes of death, as confirmed for the period 2016-2018.
They are currently the leading cause of maternal mortality under one year of age (17%), with an MMR of 1.9/100,000 live births, or approximately one maternal death from psychiatric causes every three weeks.
If we look at 12 months postpartum, the suicide rate is thus twice that of cardiovascular disease as a cause of maternal death.
However, cardiovascular disease remains the leading cause of death (14% of maternal deaths) within 42 days of pregnancy.
As for obstetric hemorrhage, which was the leading cause of maternal mortality ten years ago, it is stabilizing (0.9 per 100,000 live births) at a level half as low as approximately fifteen years ago.
Thus, during the period 2016-2018, venous thromboembolism, amniotic embolism, cerebrovascular accident (CVA) and hemorrhage are among the other most commonly observed causes with an average ratio of about 0.9 deaths per 100,000 live births.
Women over 35 are at greater risk
The risk of maternal mortality increases as women age compared to women aged 20 to 24 years.
In fact, for this age group the relative risk is 1.4, then rises to 2.6 for women aged 35 to 39 years and reaches 5.3 for women over 40 years of age.
In addition to age, women are at increased risk of maternal mortality based on a number of other characteristics. For example, women born in sub-Saharan Africa have a 3.1 times higher risk than women born in France.
In addition, obesity and socioeconomic vulnerability exacerbate this risk: obese women have twice the risk of maternal mortality compared with women of normal weight (26% compared to 13%), while vulnerable women have a risk of 34% compared to 22% for those who don’t.
Finally, geographic location plays an important role. Overseas departments and regions pose twice the risk of maternal mortality compared to the capital city average.
However, this ratio tends to decrease compared to previous studies. On mainland France, the regions of Provence-Alpes-Côte d’Azur, Hautes-de-France and Île-de-France have maternal mortality rates of 13 to 14.5 per 1000 live births, which is close to the rates in the EMDR.
On the other hand, the Occitanie region has the lowest rate in the country, with less than 7 deaths per 100,000 live births.
30 Key Messages to Improve Your Situation
The authors believe that ” 60% of maternal deaths are preventable (for 17%) or possibly (for 43%). “, the most common factor is the inadequacy of the care provided.
Therefore, a committee of experts prepared a document containing 30 key ideas for improving prevention, screening, and care coordination.
It is provided that ” personal and family risk factors perinatal depression should be known to specialists and in demand throughout pregnancy monitoring and postpartum “or even this” any respiratory symptoms ” should lead to a search for a cardiac origin.
Source : Maternal mortality in France: better understanding for better prevention. 7th report of the Confidential National Inquiry into Maternal Mortality (ENCMM), 2016–2018. (April 3, 2024).
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