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Urinary kallikrein:creatinine ratio: a possible predictor of pre‐eclampsia

Maternal mortality continues to fall in the United Kingdom, but the rate in immigrants is greater than in women born in Britain. This increased risk of maternal death may be due to genetic factors, environmental differences before and after immigration, and differences in access to and quality of health care. Using information from the Office of Population Censuses and Surveys, Judith Ibison and her colleagues examine this problem on pages 973-980. The authors analysed 1341 maternal deaths in England and Wales between 1970 and 1985 and compared maternal mortality in immigrant and British-born women. After adjusting for the confounding factors of age and year of death the relative risk of maternal mortality was increased in some immigrant groups, being twice as great in women from certain parts of Europe and from Asia, and five times as great in women from Africa and the Caribbean. Ibison and her colleagues also studied the causes of maternal mortality, adjusted for age: maternal death due to choriocarcinoma, abortion, ectopic pregnancy, hypertensive disease in pregnancy and postpartum haemorrhage was more common in West African and Caribbean women. The authors acknowledge that their study cannot unravel all the factors accounting for this increased risk of maternal death and make a plea for additional routinely collected information, perhaps by tabulation of maternal mortality by country of origin, which used to be a part of the Reports of Confidential Enquiries into Maternal Deaths.