BACKGROUND Life-threatening maternal near miss (MNM) morbidity can have long-term consequences for the physical, psychological, sexual, social, and economic wellbeing of female individuals. The lifetime risk of MNM (LTR-MNM) quantifies the probability that a female individual aged 15 years will have an MNM before age 50 years, given current mortality and fertility rates. We compare the LTR-MNM globally to reveal inequities in the cumulative burden of severe maternal morbidity across the reproductive life course. METHODS We estimated the LTR-MNM for 40 countries with multifacility, regional, or national data on the prevalence of MNM morbidity measured using WHO or modified WHO criteria of organ dysfunction from 2010 onwards (Central and Southern Asia=6, Eastern and Southeastern Asia=9, Latin America and the Caribbean=10, Northern Africa and Western Asia=2, sub-Saharan Africa=13). We also calculated the lifetime risk of severe maternal outcome (LTR-SMO) as the lifetime risk of maternal death or MNM. FINDINGS The LTR-MNM ranges from a 1 in 269 risk in Viet Nam (2010) to 1 in 6 in Guatemala (2016), whereas the LTR-SMO ranges from a 1 in 201 risk in Malaysia (2014) to 1 in 5 in Guatemala (2016). The LTR-MNM is a 1 in 20 risk or higher in nine countries, seven of which are in sub-Saharan Africa. The LTR-SMO is a 1 in 20 risk or higher in 11 countries, eight of which are in sub-Saharan Africa. The relative contribution of the LTR-MNM to the LTR-SMO ranges from 42% in Angola to 99% in Japan. INTERPRETATION There exist substantial global and regional disparities in the cumulative burden of severe maternal morbidity across the reproductive life course. The LTR-MNM is an important indicator to highlight the magnitude of inequalities in MNM morbidity, once accounting for obstetric risk, fertility rates, and mortality rates. The LTR-SMO can be used to highlight variation in the relative importance of morbidity to the overall burden of maternal ill-health across the female reproductive life course, given countries' stage in the obstetric transition. Both the LTR-MNM and LTR-SMO can serve as important indicators to advocate for further global commitment to end preventable maternal morbidity and mortality. FUNDING UK Economic and Social Research Council, EU Horizon 2020 Marie Curie Fellowship, and Leverhulme Trust Large Centre Grant.

中文翻译：

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亚洲、非洲、中东和拉丁美洲孕产妇未遂事故发病率的终生风险：跨国系统分析。


背景 危及生命的孕产妇未遂事故 （MNM） 发病率会对女性个体的身体、心理、性、社会和经济福祉产生长期影响。MNM 的终生风险 （LTR-MNM） 量化了考虑到目前的死亡率和生育率，15 岁女性个体在 50 岁之前患有 MNM 的可能性。我们在全球范围内比较 LTR-MNM，以揭示整个生殖生命过程中严重孕产妇发病率累积负担的不平等。方法 我们估计了 40 个国家的 LTR-MNM，这些数据具有从 2010 年起使用 WHO 或修改后的 WHO 器官功能障碍标准测量的 MNM 发病率患病率的多设施、区域或国家数据 （中亚和南亚=6，东亚和东南亚 =9，拉丁美洲和加勒比地区 =10，北非和西亚 =2，撒哈拉以南非洲 = 13）。我们还将严重孕产妇结局的终生风险 （LTR-SMO） 计算为孕产妇死亡或 MNM 的终生风险。调查结果LTR-MNM 的风险从越南的 1/269 （2010） 到危地马拉的 1/6 （2016） 不等，而 LTR-SMO 的风险从马来西亚的 1/201 风险（2014 年）到危地马拉的 1/5 风险（2016 年）不等。在 9 个国家/地区，LTR-MNM 的风险为 1/20 或更高，其中 7 个国家位于撒哈拉以南非洲。在 11 个国家/地区，LTR-SMO 的风险为 1/20 或更高，其中 8 个国家位于撒哈拉以南非洲。LTR-MNM 对 LTR-SMO 的相对贡献从安哥拉的 42% 到日本的 99% 不等。解释 在整个生育生命过程中，严重孕产妇发病率的累积负担存在很大的全球和区域差异。 LTR-MNM 是强调 MNM 发病率不平等程度的重要指标，曾经考虑了产科风险、生育率和死亡率。鉴于各国在产科过渡阶段，LTR-SMO 可用于强调发病率对女性生殖生命过程中孕产妇健康不良总体负担的相对重要性的变化。LTR-MNM 和 LTR-SMO 都可以作为重要指标，倡导全球进一步致力于消除可预防的孕产妇发病率和死亡率。资助英国经济和社会研究委员会、欧盟地平线 2020 居里夫人奖学金和 Leverhulme Trust 大型中心赠款。