Reducción de la mortalidad materna por preeclampsia mediante la aplicación de un modelo biopsicosocial en Colombia

Abstract

Objective: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for thirteen years (1998-2010). An interrupted timeseries analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Nine years after its introduction the general maternal mortality rate was significantly reduced (25%, p= 0.024). This was mainly due to the reduction of maternal mortality attributed to preeclampsia (45%). The maternal mortality rate due to labour complications was correlated with the incidence of preeclampsia (adjusted R2= 0.62 CI 95% 0.27-0.94, P= 0.006). The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant correlation (p= 0.042). Conclusions: Maternal mortality was reduced after the implementation of a comprehensive national prenatal care program.