981: Global associations between obesity, access to care, and maternal mortality

Abstract

To evaluate global associations between maternal mortality ratios (MMR) and obesity and access to reproductive care MMR and female obesity rates were gathered for 2015 from the World Health Organization Global Health Observatory data repository. This repository was also used for data on antenatal care coverage for > 4 visits and “family planning needs satisfied” (FP) among reproductive age women married or in-union. If 2015 was unavailable, the year or range of years closest to 2015 was used. Linear regression was used to evaluate associations between MMR and obesity, antenatal care coverage, and FP. Analyses were repeated after stratifying countries by 2015 World Bank income group. Associations between MMR and obesity were also evaluated after grouping countries into quartiles based on obesity rates. A p < 0.05 was statistically significant. For all countries, MMR increased as obesity, antenatal care coverage, and FP decreased (p< 0.001 for all). However, these associations differed between countries. For obesity, there was a nonsignificant trend for MMR to increase as obesity increased in high income countries, a trend for MMR to decrease as obesity increased in upper and lower middle income countries, and no association in low income countries (Fig 1). After stratification into quartiles by obesity, MMR increased as obesity increased among countries in the lowest obesity quartile, but decreased as obesity increased in the lower middle quartile. There was no association in the upper middle and highest quartiles of obesity (Fig 2). MMR decreased as antenatal care coverage increased among countries in the upper and lower middle income groups only, and as FP increased in the lower middle and lower income groups (Fig 1). On a global level, relationships between MMR and obesity and proxies for access to reproductive care are complex and may vary between countries. These findings support the need for individualized measures within countries to reduce maternal mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)