Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

K G Fernandes; M L Costa; S M Haddad; M A Parpinelli; M H Sousa; J G Cecatti; The Brazilian Network For Surveillance Of Severe Maternal Morbidity Study Group

doi:10.1155/2019/2594343

Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

Biomed Res Int. 2019 Jul 30:2019:2594343. doi: 10.1155/2019/2594343. eCollection 2019.

Authors

K G Fernandes¹, M L Costa¹, S M Haddad¹, M A Parpinelli¹, M H Sousa², J G Cecatti¹; The Brazilian Network For Surveillance Of Severe Maternal Morbidity Study Group³

Affiliations

¹ Department of Obstetrics and Gynaecology, University of de Campinas (UNICAMP), School of Medicine, Campinas, São Paulo, Brazil.
² Jundiai School of Medicine, Jundiaí, São Paulo, Brazil.
³ The Coordinating Institution, The Obstetric Unit from the School of Medical Sciences, University of Campinas, Brazil.

Abstract

Background: Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity.

Methods: This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PR_adj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race.

Results: Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis.

Conclusion: Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

MeSH terms

Adolescent
Adult
Brazil / epidemiology
Female
Humans
Live Birth / epidemiology
Maternal Mortality*
Pregnancy
Pregnancy Complications / epidemiology*
Pregnancy Complications / mortality
Pregnancy Outcome / epidemiology
Skin Pigmentation*
White People
Young Adult