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Impact of Emerging Virus Pandemics on Cause-Specific Maternal Mortality Time Series: A Population-Based Natural Experiment Using National Vital Statistics, Argentina 1980-2017

27 Pages Posted: 19 Jul 2021

See all articles by Maria Elena Critto

Maria Elena Critto

MELISA Institute - Division of Epidemiology

Yordanis Enriquez

Universidad Católica Sedes Sapientiae - Facultad de Ciencias de la Salud

Miguel Bravo

MELISA Institute - Division of Epidemiology

Lenin de Janon Quevedo

Pontificia Universidad Católica de Argentina - Facultad de Ciencias Médicas

Ruth Weinberg

University of Buenos Aires (UBA) - Faculty of Medicine

Adolfo Etchegaray

Universidad Austral - Hospital Universitario Austral

Elard S. Koch

MELISA Institute - Division of Epidemiology

More...

Abstract

Background: Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics.

Methods: We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS).

Findings: Over this 38-year study, the MMR decreased by 58·6% (69·5 to 28·8 deaths/100,000 live births), transitioning from direct obstetric causes (67·0 to 21·1/100,000 live births; 68·4% decrease) to indirect causes (2·6 to 7·7/100,000 live births; 196·2% increase). The regression analysis showed an average reduction of -2·2%/year (95% CI: -2·9 to -1·4) with 2 joinpoints in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from respiratory system- and sepsis-related complications (level change 4·7 and 1·6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities.

Interpretation: The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from respiratory system- and sepsis-related complications.

Funding: FISAR, EPI-092018-01 and ONE-052021-01.

Declaration of Interest: None to declare.

Ethical Approval: This study was approved by an institutional review board from Pontificia Universidad Católica Argentina.

Suggested Citation

Critto, Maria Elena and Enriquez, Yordanis and Bravo, Miguel and Quevedo, Lenin de Janon and Weinberg, Ruth and Etchegaray, Adolfo and Koch, Elard S., Impact of Emerging Virus Pandemics on Cause-Specific Maternal Mortality Time Series: A Population-Based Natural Experiment Using National Vital Statistics, Argentina 1980-2017. Available at SSRN: https://ssrn.com/abstract=3889415 or http://dx.doi.org/10.2139/ssrn.3889415

Maria Elena Critto

MELISA Institute - Division of Epidemiology ( email )

Concepción, 4133515
Chile

Yordanis Enriquez

Universidad Católica Sedes Sapientiae - Facultad de Ciencias de la Salud ( email )

Lima, 15302
Peru

Miguel Bravo

MELISA Institute - Division of Epidemiology ( email )

Concepción, 4133515
Chile

Lenin de Janon Quevedo

Pontificia Universidad Católica de Argentina - Facultad de Ciencias Médicas ( email )

Argentina

Ruth Weinberg

University of Buenos Aires (UBA) - Faculty of Medicine ( email )

Argentina

Adolfo Etchegaray

Universidad Austral - Hospital Universitario Austral ( email )

Argentina

Elard S. Koch (Contact Author)

MELISA Institute - Division of Epidemiology ( email )

Concepción, 4133515
Chile