Quality of life after maternal near miss: A systematic review.

INTRODUCTION Maternal near miss is a major global health issue and approximately seven million women worldwide experience it each year. Maternal near miss can have several different health consequences and affect the women's quality of life, yet little is known about the size and magnitude of this association. The aim of this study was to assess the evidence of the association between women who have experienced maternal near miss and quality of life compared to women who had an uncomplicated pregnancy and delivery. MATERIAL AND METHODS Cochrane library, Embase, CINAHL, Web of science, Medline, Scopus and PubMed were searched for published studies. Studies were selected according to the PECO model (population, exposure, control, and outcome), and were included if they investigated quality of life as an outcome after maternal near miss among women of all ages with no limitation on country or time (up to June 2020). Maternal near miss was defined as a life-threatening condition arising from complications related to pregnancy and/or childbirth. The quality of the studies was assessed according to the Newcastle-Ottawa scale and a forest plot was constructed based on quality of life outcomes and study quality. PROSPERO registration number: CRD42020169232. RESULTS Fifteen studies were included in the review with a total of 31,558 women. Quality of life was reported in various ways, and 25 different confounders were controlled for. Compared to women who did not experience maternal near miss, women exposed to maternal near miss had an overall lower quality of life (n=2/2), had poorer mental (n=6/10) and social health (n=2/3) and maternal near miss had negative economic consequences (n=4/4). Maternal near miss was not associated with sexual dysfunction (n=1/5). Ten out of fifteen studies were assessed as being of poor quality. CONCLUSIONS Evidence shows that maternal near miss is negatively associated with various aspects of quality of life. This highlights the importance of addressing the adverse effects associated with maternal near miss and follow up maternal near miss after discharge. Quality of life is a multidimensional concept that is assessed in various ways, and the literature on the field is heterogenous. More high-quality studies are needed.