Health of women after severe obstetric complications in Burkina Faso: a longitudinal study

Abstract

Background: Little is known about the health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect a range of health, social, and economic indicators in the first year post partum.

Methods: We did a prospective cohort study of women with severe obstetric complications recruited in hospitals when their pregnancy ended with a livebirth (n=199), perinatal death (74), or a lost pregnancy (64). For every woman with severe obstetric complications, two unmatched control women with uncomplicated delivery were sampled in the same hospital (677). All women were followed up for 1 year.

Findings: Women with severe obstetric complications were poorer and less educated at baseline than were women with uncomplicated delivery. Women with severe obstetric complications, and their babies, were significantly more likely to die after discharge: six (2%) of the 337 women with severe obstetric complications died within 1 year, compared with none of the women with uncomplicated delivery (unadjusted p=0.001); 17 babies of women with severe obstetric complications died within 1 year, compared with 18 of those born by uncomplicated delivery (hazard ratio for mortality 4.67, 95% CI 1.68-13.04, adjusted for loss to follow-up and confounders; p=0.003). Women with severe obstetric complications were significantly more likely to have experienced depression and anxiety at 3 months (odds ratio 1.82, 95% CI 1.18-2.80), to have experienced suicidal thoughts within the past year at all time points (2.27, 1.33-3.89 at 3 months; 2.30, 1.17-4.50 at 6 months; 2.26, 1.30-3.95 at 12 months), and to report the pregnancy having had a negative effect on their lives at all time points (1.54, 1.04-2.30 at 3 months; 2.30, 1.56-3.39 at 6 months; 2.44, 1.63-3.65 at 12 months) than were women with uncomplicated delivery.

Interpretation: Women who give birth with severe obstetric complications are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that these women receive adequate care before and after discharge from hospital.