Vital Signs

Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017

Emily E. Petersen, MD; Nicole L. Davis, PhD; David Goodman, PhD; Shanna Cox, MSPH; Nikki Mayes; Emily Johnston, MPH; Carla Syverson, MSN; Kristi Seed; Carrie K. Shapiro-Mendoza, PhD; William M. Callaghan, MD; Wanda Barfield, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(18):423-429. 

In This Article

Abstract and Introduction

Abstract

Background: Approximately 700 women die from pregnancy-related complications in the United States every year.

Methods: Data from CDC's national Pregnancy Mortality Surveillance System (PMSS) for 2011–2015 were analyzed. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics. The distribution of pregnancy-related deaths by timing relative to the end of pregnancy and leading causes of death were calculated. Detailed data on pregnancy-related deaths during 2013–2017 from 13 state maternal mortality review committees (MMRCs) were analyzed for preventability, factors that contributed to pregnancy-related deaths, and MMRC-identified prevention strategies to address contributing factors.

Results: For 2011–2015, the national PRMR was 17.2 per 100,000 live births. Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white (white) women (13.0). Timing of death was known for 87.7% (2,990) of pregnancy-related deaths. Among these deaths, 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% 1–6 days postpartum, 21.4% 7–42 days postpartum, and 11.7% 43–365 days postpartum. Leading causes of death included cardiovascular conditions, infection, and hemorrhage, and varied by timing. Approximately sixty percent of pregnancy-related deaths from state MMRCs were determined to be preventable and did not differ significantly by race/ethnicity or timing of death. MMRC data indicated that multiple factors contributed to pregnancy-related deaths. Contributing factors and prevention strategies can be categorized at the community, health facility, patient, provider, and system levels and include improving access to, and coordination and delivery of, quality care.

Conclusions: Pregnancy-related deaths occurred during pregnancy, around the time of delivery, and up to 1 year postpartum; leading causes varied by timing of death. Approximately three in five pregnancy-related deaths were preventable.

Implications for Public Health Practice: Strategies to address contributing factors to pregnancy-related deaths can be enacted at the community, health facility, patient, provider, and system levels.

Introduction

Approximately 700 women die annually in the United States from pregnancy-related complications.[1] Significant racial/ethnic disparities in pregnancy-related mortality exist; black women have a pregnancy-related mortality ratio approximately three times as high as that of white women.[2,3] Better understanding is needed on the circumstances surrounding pregnancy-related deaths and strategies to prevent future deaths.

This report describes the timing and characteristics of pregnancy-related deaths in the United States using 2011–2015 national CDC Pregnancy Mortality Surveillance System (PMSS) data. Data from 13 state maternal mortality review committees (MMRCs) during 2013–2017 were used to determine the percentage of pregnancy-related deaths that were preventable and factors that contributed to the deaths. MMRC-identified strategies for prevention are reported.

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