Maternal morbidity: a longitudinal study of women’s health during and up to 22 months after pregnancy in Jamaica

The sustainable development goals aim to improve health and well-being for all. Our study sought to evaluate factors associated with ill-health in women during and after pregnancy. A population-based longitudinal study of women who delivered a singleton live-born baby in a 3-month period across Jamaica was conducted. Socio-demographic factors, perception of health, chronic illnesses and frequency and reasons for hospital admission were assessed during pregnancy; within 24-48 hours after birth; up to 12 months and up to 22 months after childbirth. This study presents data for women participating in all four assessments. Relationships between ill-health and maternal characteristics were estimated using log-normal regression analysis. Of 9,742 women interviewed at birth, 1,311 were assessed at all four stages, 27.7% of whom reported ill-health at least once. Hospitalization rates were 20.9% during pregnancy, 6.1% up to 12 months and 0.5% up to 22 months after childbirth. Complications related to pregnancy accounted for 69.3% of antenatal admissions. Ill-health, reported by 11% of women, was less likely with better education (RR=0.62, 95%; 0.42-0.84). Hospital admission was associated with a higher socio-economic status (RR=1.33, 95% 1.04-1.70) and delivery by Caesarean section [CS] (RR=1.57, 95%; 1.21-2.04). One in three (33.7%) women recorded ongoing chronic illnesses after childbirth. These were more likely with an increase in age and parity and was associated with delivery by elective CS (RR=1.44, 95%; 1.20-1.73). In multivariable analyses, ill-health was more likely with chronic illness (RR=2.06, 95%; CI: 1.71-2.48) and hospital admission from 12 to 22 months after childbirth (RR=1.54, 95% CI: 1.12-2.12). Ill-health during pregnancy and after childbirth represent a significant burden of disease. A standardised comprehensive approach to measuring and addressing this disease burden will ensure that women and their babies survive and thrive during and after pregnancy.

Keywords: indicators, maternal morbidity, pregnancy, postnatal, assessment.

Short Title: Maternal morbidity during pregnancy and up to 22 months after birth.

Ethical approval: Ethical approval was granted by the University of the West Indies Ethics Committee (Mona) and the Ministry of Health's Advisory Panel on Medico - Legal Affairs, Kingston, Jamaica.

Funding received: The JA Kids study was funded by a grant to the University of the West Indies from the Inter-American Development Bank (IDB) (Project number ATN/JF-12312-JA). Secondary data analysis at the Centre for Maternal and Newborn health in the UK was funded through a Global Health Grant (Project number OPP1033805) from the Bill and Melinda Gates Foundation and World Health Organization (WHO).