Maternal Mortality in Goiás: Causes of Maternal Death and Barriers to Underreporting

Objective To describe the causes of maternal deaths and estimate the magnitude of maternal mortality in the state of Goiás, considering the underreporting of maternal deaths from 2016 to 2021.

This is a descriptive study that linked data from the Mortality Information System (SIM in Portuguese) and the Live Birth Information System (SINASC in Portuguese) using a linkage procedure. The aim was to identify maternal deaths and their causes and calculate the Maternal Mortality Ratio (MMR).

A total of 417 maternal deaths were officially reported in Goiás from 2016 to 2021. Among these, 291 matches were identified between the systems, including 239 cases where the declared underlying cause was maternal death, 17 with presumed causes, and 35 with other causes. The leading causes of death for maternal deaths, deaths with presumed causes, and other deaths were, respectively: other obstetric conditions not elsewhere classified; symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified; and certain infectious and parasitic diseases. Considering only declared maternal deaths, the MMR ranged from 55.79 (2016) to 137.46 (2021) deaths per 100,000 live births (LB), reflecting a 146% increase. Considering the inclusion of deaths identified through linkage, the MMR ranged from 55.79 (2016) to 157.41 (2021) deaths per 100,000 LB, representing an 182% increase.

The underestimation of MMR values was adjusted compared to direct estimates using the SIM and SINASC systems. This indicates that maternal mortality is higher than reflected in official statistics. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Research Ethics Committee of the Federal University of Goiás Leide das Neves Research Ethics Committee Health Department of the State of Goiás, Brazil I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability We hereby declare that we are making the data used in this research partially available. We have sent a file with de-identified data containing all the information that was analyzed in our study. The part of the data that was not sent is personal information, such as full name and address, of the research participants. To also obtain access to this data, it is necessary to obtain approval from the Leide das Neves Ethics Committee and subsequent provision of the data by the Health Department of the State of Goiás, Brazil.