Dr Melanie Nana1, Dr Kate Williams1, Dr Catherine Tew1, Dr Charline Bradshaw1, Professor Luigi Camporota1, Professor Catherine Nelson-Piercy1
1Guy's And St Thomas' NHS Foundation Trust, London, England
Biography:
Melanie is an Obstetric Medicine Registrar at St Thomas' Hospital and NIHR Research Training Fellow at King’s College London
Abstract:
Background: UK maternal morbidity and mortality has increased; ethnic minority women remain at highest risk. Causes of these disparities are being explored. Intensive care unit (ICU) admission is required for those with severe illness with high mortality risk.
Objectives: To explore association between ethnicity and likelihood of admission to ICU in pregnancy and the puerperium. To describe the characteristics and outcomes of the women admitted.
Methods: A database was assembled using electronic health records from the tertiary ICU and maternity service at St Thomas’ Hospital, London. Women admitted to ICU during pregnancy or within six-weeks postpartum (April 2010-September 2023) were included. Admission by ethnicity was compared to the South-East London background pregnant population and maternal/neonatal characteristics are described. Categorical data are reported as median [interquartile range].
Results: 177 women were admitted to ICU during pregnancy and 346 postpartum. Black ethnicity women were more likely to be admitted than White during pregnancy (OR 2.1, 95% CI 1.4-3.1) and postpartum (OR 3.9, 95% CI 3.0-5.0). In Asian women likelihood only increased postpartum (OR 1.8, 95% CI 1.2-2.7). Social deprivation indices were lower in Black (3rd decile [2-4]) and Asian (4th [3-7]) compared with White women (5th [3-8]). No differences were found in age, body mass index, number of co-morbidities or APACHE score on admission. Indirect causes represented the commonest reason for admission in pregnancy (most frequently respiratory in Black and White women; endocrine in Asian), direct in the postpartum period. There was no difference in maternal survival or length of stay between ethnicities. In those admitted during pregnancy, delivery gestation was 31+1 [26+3-35+6] in Asian women, 34+6 [26+6-38+1] in Black and 36+0 [34+1-37+6] in white; live birth and caesarean section rates did not differ.
Conclusion: Ethnic minority pregnant women have increased risk of ICU admission not entirely explained by maternal characteristics.
Keywords
Intensive Care Medicine; pregnancy; ethnic disparities
References
Knight M, Bunch K, Patel R, et al. Saving Lives, Improving Mothers' Care- CORE report lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21