Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review

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ABSTRACT

Background

The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies.

Objective

To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic.

Methods

We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality.

Results

The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda.

Conclusions

Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development.

KEYWORDS:

• Maternal deaths
• maternal mortality ratio
• rapid systematic review
• Sars-Cov-2

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We would like to thank librarian Kate Perris for her guidance on the search strategy, and David Bell and Agnes Kiragga for providing additional data for this review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

CC, WJG & JJ conceived of the study and with FP conducted all aspects of the systematic review. JC, SF, EF & LS contributed text panels to the paper. CC and WJG undertook the main drafting of the paper, and all authors contributed to revisions to the draft and approved the final version.

Paper context

The impact of COVID-19 on maternal mortality remains uncertain. In this review, we identify seven studies measuring maternal mortality during the COVID-19 period compared to pre-COVID-19, all of which suggest an upward trend. However, drawing firm conclusions was challenging due to methodological differences and weaknesses in the included studies. High-quality data on the impact of COVID-19 on maternal mortality are urgently needed to inform health systems response to the ongoing COVID-19 and to future pandemics.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The authors did not receive any funding for the specific conduct of this systematic review.