Report backs up link between smoking, obesity and stillbirth

Report backs up link between smoking, obesity and stillbirth

A report from the Perinatal and Maternal Mortality Review Committee (PMMRC) has provided further evidence of the link between smoking, obesity and stillbirth.

The PMMRC is responsible for reviewing maternal deaths and all deaths of babies from 20 weeks gestation up to 28 days after birth, or weighing at least 400g if gestation is unknown. It advises the Health Quality & Safety Commission on how to reduce these deaths.

In its annual report released today, the Committee says national maternity data shows a clear link between stillbirth and smoking, and stillbirth and being overweight, backing up the findings in published studies. The data captures maternity information from lead maternity carers and public hospitals. The analysis also showed that women of Indian ethnicity and women having their first baby were at higher risk of stillbirth.

PMMRC Chair Dr Sue Belgrave says the findings show how critical it is to ensure pregnant women receive as much help and support as possible to quit smoking and have a healthy weight both before and during pregnancy.

“Stillbirth is often unexplained, but where we do know how to reduce risk we need to make sure this information is widely available so women have the opportunity to reduce their own risk of stillbirth.

“Every effort must be made to encourage women to take part in smoking cessation programmes before, during and after pregnancy. There are a number of ways that women, including pregnant women, can get help to quit smoking. Further information can be found at Quitline. (The website is available at: http://www.quit.org.nz/23/reasons-to-quit/smoking-and-pregnancy).

“Likewise, weight loss before pregnancy is recommended for women who are obese and pregnant women should be encouraged to maintain a healthy diet and monitor their weight gain during pregnancy.”

The report found there were 10 maternal deaths in 2012. Two deaths were due to complications of pregnancy and 8 were related to pre-existing diseases or suicide. The maternal mortality rate – the death of a mother while pregnant or up to six weeks after birth – was 16 women in every 100,000 pregnancies. There has been no statistically significant change in the maternal death rate since PMMRC began analysing maternal mortality data in 2006.

The perinatal mortality rate – the death of a baby from 20 weeks gestation up to 28 days after birth – has also remained stable, at 10.7/1000 births. This is equivalent to one baby dying in pregnancy or during the first month of life for every 100 babies born. New Zealand’s perinatal mortality rates are comparable to rates in Australia and the United Kingdom. It is pleasing to note there has been a significant reduction in deaths using the World Health Organization definition of babies weighing more than 1000gm.

Dr Belgrave says there has also been a significant reduction in unexplained stillbirths and deaths of term babies during labour due to lack of oxygen.

“While further research is needed to clarify the reasons for these reductions, this is obviously very good news. The PMMRC has developed a tool to assess each death for contributory factors with a focus on preventing the deaths that we can.

“The reduction in unexplained stillbirths means more parents are being given a reason as to why their baby dies, which helps with the grieving process and planning for future pregnancies.”

Other key report findings

• The risk of maternal death for women living in most deprived areas is 2.5 time that of those living in the least deprived areas.

• Maori and Pacific mothers are three times more likely to die while pregnant or up to six weeks after birth than non-Maori, non-Pacific mothers.

• Maori and Pacific women, women who smoke during pregnancy, women living in poorer areas and women having their first babies are at increased risk of neonatal death of babies born between 20-27 weeks (a baby born alive between 20 to 27 weeks gestation who dies prior to 28 days of life).

• Women who smoke during pregnancy are at increased risk of neonatal death of babies born from 28 weeks gestation.

• The incidence of neonatal encephalopathy, a condition usually resulting from lack of oxygen to the brain around the time of birth, is significantly higher among babies of Pacific mothers than among babies of New Zealand European mothers.

• In 2012, 78 percent of babies with moderate to severe neonatal encephalopathy received induced cooling, to reduce damage related to lack of oxygen.

Report Recommendations

The report includes the following recommendations

Perinatal-related mortality

• Efforts must be made to encourage women to engage in effective smoking cessation programmes prior to, during and after pregnancy.

• Initiatives to prevent obesity prior to pregnancy and promote healthy weight gain in pregnancy should be supported.

• Addressing the impact of poverty requires wider societal commitment as has been highlighted in the recent Health Select Committee report on improving child health outcomes.

Maternal mortality

• Women who are unstable or clinically unwell should be cared for in the most appropriate place and be under close observation.

• Women with serious pre-existing medical conditions require a multidisciplinary management plan for the pregnancy, birth and postpartum period.

Neonatal encephalopathy

• All DHBs should undertake local review of cases of neonatal encephalopathy to identify areas for improvement in care including adequacy of resuscitation and cooling.

• A guideline for the investigation and management of neonatal encephalopathy should be developed.

The full report can be downloaded here: http://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/publications-and-resources/publication/1576

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Perinatal and Maternal Mortality Review Committee (PMMRC) Annual Report

Frequently Asked Questions, Embargoed to 8am, 17 June 2014

What is New Zealand’s perinatal death rate?

In 2012, there were 669 deaths of babies aged from 20 weeks gestation to less than 28 days old (or weighing at least 400g if gestation was unknown). This is a rate of 10.7 deaths per 1000 births, using the New Zealand definition for these deaths. This rate is unchanged across the years 2007 to 2012.

What is the main cause of perinatal death in New Zealand?

The main cause of perinatal death in New Zealand is congenital abnormality, which accounts for 30 percent of deaths. The second most common cause of death is spontaneous preterm birth which accounts for 15 percent of all perinatal deaths.

How does New Zealand’s perinatal death rate compare internationally?

New Zealand’s perinatal mortality rates in 2012 are comparable to 2012 rates in the United Kingdom and 2011 rates in Australia.

How many deaths were avoidable?

Nineteen percent of perinatal deaths for 2012 were identified by local review as potentially avoidable. Factors commonly contributing to these deaths included caregivers not following recommended best practice, infrequent antenatal care and lack of recognition by patients and their families of the complexity or seriousness of their condition.

Are there any groups more at risk of losing a baby?

Maori, Pacific and Indian mothers were significantly more likely to lose a baby than New Zealand European mothers.

How many babies had neonatal encephalopathy?

In the three years 2010 to 2012, 227 babies were reported as having neonatal encephalopathy, a syndrome usually resulting from lack of oxygen to the brain around the time of birth.

Seventy-eight percent of babies with moderate and severe neonatal encephalopathy received induced cooling therapy, as recommended, to reduce injury related to lack of oxygen.

The incidence of neonatal encephalopathy is significantly higher among babies of Pacific mothers than among babies of New Zealand European mothers. The incidence of neonatal encephalopathy increases with increasing socioeconomic deprivation.

What was the maternal death rate?

In 2012, there were 10 maternal deaths, 2 direct deaths from obstetric complications and 8 due to pre-existing disease that was aggravated by the pregnancy. . A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy. The rate was 16.0/100,000 maternities. There has been no statistically significant change in the maternal death rate since PMMRC began analysing maternal mortality data in 2006.

Were any of the maternal deaths preventable?

Between 2006 and 2012, 34 percent of maternal deaths were identified as potentially avoidable. In 60 percent of maternal deaths during this timeframe, there were contributing factors relating to organisation and management (lack of policies, protocols or guidelines, inadequate systems/process for sharing of clinical information between services), personnel (lack of recognition of complexity or seriousness of condition by caregiver, knowledge and skills of staff were lacking), and barriers to access and/or engagement with care (lack of recognition of complexity or seriousness of condition, no or infrequent antenatal care.)