Maternal Mortality Ratio Has Doubled in 23 Years

Lara C. Pullen, PhD

December 09, 2014

The US pregnancy-related mortality ratio has continued to increase, rising to 16.0 deaths per 100,000 live births. The latest epidemiologic data from 2006 to 2010 suggest that cardiovascular conditions and infection contributed to the increase in pregnancy-related mortality. The fact that chronic diseases are playing a larger role in pregnancy-related mortality suggests there has been a change in the risk profile of the birthing population.

Andreea A. Creanga, MD, PhD, and colleagues from the Centers for Disease Control and Prevention, Atlanta, Georgia, published this update of the national population-level pregnancy-related mortality estimates online December 5 and in the January issue of Obstetrics & Gynecology.

The Pregnancy Mortality Surveillance System was first implemented in 1987. The investigators compared causes of pregnancy-related deaths from 2006 to 2010 with causes of pregnancy-related deaths since 1987.

From 2006 to 2010, there were 3358 pregnancy-related deaths and 5028 pregnancy-associated deaths documented in the United States. During this same period, the contribution of more traditional causes of pregnancy-related death such as hemorrhage, hypertensive disorders of pregnancy, and embolism continued the decline that began in 1987. Racial disparities in pregnancy-related mortalities persisted, however, with non-Hispanic black women being 3.2 times more likely to die of pregnancy complications than non-Hispanic white women.

The team acknowledged that pregnancy-related deaths may be undercounted, particularly in states that do not send linked maternal death and birth and fetal certificate data to the Centers for Disease Control and Prevention.

Maternal Health

"We can no longer afford to act as if this is someone else's problem to address. Change what is in your power to change to prevent more pregnant and postpartum women from dying potentially preventable deaths," Nancy C. Chescheir, MD, editor-in-chief of Obstetrics & Gynecology, writes in an accompanying editorial. Her editorial was a call to action for physicians.

Dr Chescheir also drew attention in her editorial to the disturbing health disparities that are based on race and ethnicity. She explained that the maternal mortality ratio reflects the status of healthcare, the status of women, and the political and social determinants of health. The latest data suggest that the United States has a long way to go to minimize the risks of maternal morbidity and mortality.

Unfortunately, the United States does not have a required, systematic analysis of maternal deaths. Countries that do have such an analysis have found that most maternal deaths were avoidable and related to substandard care. The three most preventable causes of maternal death and disease are obstetric hemorrhage, hypertensive disorders of pregnancy, and venous thromboembolism.

Adherence to treatment guidelines and protocols can decrease maternal morbidity and mortality. In particular, women with identified risks in the antepartum period should be given a higher level of surveillance and care. This care can be achieved either within the physician's office or through referral to specialists who can provide a higher level of care.

Preventable Accidents

Dr Chescheir also pointed out that although the majority of pregnancy-related deaths occur around the time of delivery, many pregnant women in the United States also die from pregnancy-associated death such as injury. Such injuries can occur during motor vehicle accidents, be self-inflicted, or be the result of intimate partner violence.

Specifically, there were 1.4 maternal deaths per 100,000 live births from motor vehicle accidents, suicide accounted for 2.0 maternal deaths per 100,000 live births, and intimate partner violence appears to contribute to 2.5 maternal deaths per 100,000 maternal deaths in the United States.

Physicians can decrease these numbers through screening, education, and interventions, she said.

The authors and Dr Chescheir have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;125:2-12. Abstract


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