Regional differences in Dutch maternal mortality

Authors

  • JP de Graaf,

    1. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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  • JM Schutte,

    1. Department of Obstetrics and Gynaecology, Isala Klinieken Zwolle, The Netherlands
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  • JJ Poeran,

    1. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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  • J van Roosmalen,

    1. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
    2. Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
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  • GJ Bonsel,

    1. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
    2. Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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  • EAP Steegers

    1. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Dr JP de Graaf, Erasmus MC, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Room Hs409, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. Email j.degraaf@erasmusmc.nl

Abstract

Please cite this paper as: de Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch maternal mortality. BJOG 2012;119:582–588.

Objective  To study regional differences in maternal mortality in the Netherlands.

Design  Confidential inquiry into the causes of maternal mortality.

Setting  Nationwide.

Population  A total of 3 108 235 live births and 337 maternal deaths.

Methods  Data analysis of all maternal deaths in the period 1993–2008.

Main outcome measure  Maternal mortality.

Results  The overall national maternal mortality ratio was 10.8 per 100 000 live births. In the 12 provinces of the Netherlands, the maternal mortality ratio ranged from 6.2 in Noord Brabant to 16.3 per 100 000 live births in Zeeland. In the four largest cities, maternal mortality varied from 9.3 in Amsterdam to 21.0 in Rotterdam. At a national level, the most frequent direct cause was pre-eclampsia. Increased risks for maternal mortality were found for women living in deprived neighbourhoods (RR 1.41), women from non-Western origin (RR 1.59), and women who were 35 years or older (RR 1.61).

Conclusion  There are significant variations in maternal mortality ratios in the Netherlands between cities, provinces, and neighbourhoods. In addition, higher maternal mortality was observed in women of non-Western origin and in women who were 35 years of age or older.

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