“The overall leading causes were congenital anomalies, spontaneous preterm labour and rupture of membranes at [under] 37 weeks,” it said.
Of the stillbirths, 28% were unexplained, and for neonatal deaths – those in the four weeks after birth – the most common cause was prematurity.
Perinatal death more likely after Covid infection during pregnancy
Five people experienced a perinatal mortality and had a confirmed Covid-19 infection in their pregnancy, but the likelihood of a pregnancy ending in perinatal death was 7.37 times higher for those with a confirmed infection compared to those without, the report said.
While the number of affected people was small and the 95% confidence interval was broad, the figure was still “significant”.
Influenza infections during pregnancy also had a “serious impact” on outcomes.
“This highlights the critical importance of improving maternal vaccination coverage in general.”
Indian, Māori and Pasifika still disproportionately affected
Ethnicity, deprivation and age inequities persist across perinatal and maternal mortality, the report said.
There continues to be worse outcomes for babies with Indian, Māori and Pacific mothers compared with New Zealand European mothers.
Indian women have the worst outcomes, with 14.41 mortalities per 1000 births. Some research suggests this may be connected to metabolic-related factors that are more common in the Indian ethnic group.
Pacific families have a rate of 12.57 deaths per 1000 births, and Māori have 12.6.
“Calls to address these inequities for tangata whenua are being actioned, and multi-agency programmes that focus on the first 1000 days (including pregnancy) are being implemented and need to be supported and strengthened to achieve equitable outcomes,” the report said.
“The health system in Aotearoa must ask itself why, compared with the European population, Māori have a 43% higher chance of perinatal related mortality from infection, Pacific peoples have double the mortality from hypertension and Indian populations have an 84% higher chance of mortality from antepartum haemorrhage. This discussion should be uncomfortable but will result in opportunities to save lives.”
People under 20 years old also have a high rate (16.63) of perinatal deaths.
Small increase of neonatal encephalopathy rates
There was some evidence over the five years to 2021 of a small increase in the rates of neonatal encephalopathy in New Zealand.
Neonatal encephalopathy (NE) is a clinically-defined syndrome of disturbed neurological function within the first week after birth in an infant born from 35 weeks’ gestation. Symptoms include breathing problems, lower levels of consciousness, seizures and depressed reflexes.
New Zealand’s national rate of NE is 1.25 per 1000 births but the data showed in 2020 the rate was slightly higher, at 1.46.
“This finding could be explained by improved detection after the implementation of the national NE consensus statement in 2019, but it is impossible to make this attribution without audit or research of the national clinical implementation of this guidance,” the report said.
It also noted Māori were the least likely group to receive an MRI after a diagnosis of NE. An MRI is recommended for all babies diagnosed with moderate to severe NE, to provide important information to predict neurodevelopmental outcomes.
Suicide biggest cause of maternal deaths
While maternal death is relatively rare in New Zealand, with only 147 deaths recorded across the 2006-2021 period, nearly half of these deaths were due to suicide.
Māori are also three times more likely than Pākehā to die by suicide in a maternity-related case.
“In Aotearoa, the effects of colonisation ... have resulted in substantial increased risks of maternal mortality for wāhine Māori, Pacific peoples and those living in poverty,” the report said.
“Although all inequities are unjust and unfair, in this context they represent a systemic failure of the maternal health systems to provide adequate care to the most at-risk groups.
“It is not too late for the health system to change, and with respect to inequity it needs to change with the goal of helping those who need it the most.”
Other “clinically significant” causes of maternal death were amniotic fluid embolisms, infection, hypertensive disorders and haemorrhage.
If the Māori and Pacific mortality rates were the same as the European rates, overall maternal mortality in Aotearoa New Zealand would be 30% lower.
Tackling pre-term birth could change death rates
Overall, there has been little change to perinatal death rates over the reporting period, but the PMMRC recommended more work be done to address pre-term birth.
Preterm birth is one of the leading causes of death, and many of these deaths were preventable, said the PMMRC’s subject matter expert, Dr Rose Elder.
“If someone has risk factors for preterm birth then with access to scanning, the opening of the uterus [cervix] can be monitored in early pregnancy and treatment to support the cervix to stay closed if needed can lower the risk of early birth.”
Other measures to help include recognising and treating health issues that contribute to pre-term birth, screening for and treating infection, providing support to stop smoking, and providing education around signs of labour, and easy and fast navigation into services once pre-term labour is suspected.
This was made easier when maternity providers had the resources, time and skills to engage with pregnant people early and in a way that was acceptable to that person, Elder said.
Melissa Nightingale is a Wellington-based reporter who covers crime, justice and news in the capital. She joined the Herald in 2016 and has worked as a journalist for 10 years.
