MOTHERS in the UK are three and a half times more likely to die during pregnancy or soon after than women in Norway, according to a new study.
Researchers evaluating outcomes across eight high-income European nations with good quality surveillance systems found that only Slovakia had higher maternal mortality rates than the UK.
The findings - published in the BMJ medical journal - are based on data gathered before the pandemic.
A separate report, published last week, showed a sharp rise in the UK's maternal mortality rate during the most recent three-year period from 2018-2020.
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The BMJ report shows that the UK's maternal mortality rate was 9.6 per 100,000 live births in 2016-18, compared to 2.7 in Norway from 2014 to 2018.
This covers deaths occurring up to 42 days after the end of pregnancy, with suicides and cardiovascular deaths, including blood clots, found to be the leading causes of maternal deaths for most of the eight countries, including the UK.
Adverse events directly relating to childbirth - such as obstetric haemorrhages or fatal complications from anaesthesia - were much rarer.
The eight countries included were: the UK, Denmark, Finland, France, Italy, the Netherlands, Norway, and Slovakia.
Previous studies comparing countries’ maternal mortality rates have tended to underestimate maternal deaths because they are based on death certificates, rather than comprehensive surveillance systems.
The data used by the BMJ was taken from the International Network of Obstetric Survey Systems (INOSS), an international collaboration aiming to gather data on serious illnesses in pregnancy and childbirth.
However, the authors caution that their country-by-country comparisons are not adjusted for differences in the socioeconomic profiles of the mothers in each nation.
They stress that "wide variations exist in the proportions, among all births, of younger and older mothers and of mothers with a migrant or minoritised ethnic background [which] may partially explain the differences in maternal mortality ratios, as those characteristics were associated with higher risks of maternal death".
In the UK, Black women are known to be nearly four times more likely than white women to die during or after pregnancy, with women of Asian ethnicity having 1.7 times the risk compared to white women.
In the BMJ study, a pooled analysis of the data by age revealed that maternal death rates were highest for both the youngest and the oldest mothers in all countries except the Netherlands.
For example, women under 20 were at twice the risk of death compared with women aged 20-29, and those aged 40 years or over were at almost four times the risk of death.
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Other factors not accounted for - such as body mass index - could also be influencing rates of cardiovascular maternal mortality, they add.
In the UK, there were 50 cardiovascular-related deaths compared to 15 in Italy and three in Norway.
However, they note that differences in maternal mortality from causes such as haemorrhage or amniotic fluid embolism, which are not linked to individual characteristics, "may suggest explanatory hypotheses related to care".
They add: "To further reduce maternal mortality by learning from best practices and each other, in-depth analyses of differences in quality of care and health system performance at national levels are needed.
"Cardiovascular diseases and mental health in women during and after pregnancy need to be prioritised in all countries."
It comes after the MBRRACE-UK report found that 229 women in the UK had died during or up to six weeks after the end of pregnancy between 2018-2020.
Excluding nine Covid-related deaths, the mortality rate - at 10.5 per 100,000 women giving birth - was 24 per cent higher than it had been in 2017-2019.
The report did not include specific breakdowns for the maternal mortality rates by constituent UK nations because of the comparatively small numbers involved.
However, it is also understood to have increased in Scotland.
In 2020 specifically, the report found that women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy compared to 2017-19
A further 289 women died between six weeks and a year after the end of pregnancy in 2018-20.
Psychiatric and cardiovascular disorders combined account for 30% of maternal deaths in the UK.
Various types of blood clot - known collectively as thrombosis and thromboembolism - were the main direct cause of death.
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