17 May Why Do 700 US Women Die of Pregnancy-Related Causes Each Year?

MedicalResearch.com Interview with:

Dr. Peterson

Emily Petersen, MD.
Lead for the Pregnancy Mortality Surveillance System
Division of Reproductive Health  

MedicalResearch.com: What is the background for this study?

Response: About 700 women die of pregnancy-related causes each year in the United States. The new analysis provides much-needed perspective on the circumstances surrounding pregnancy-related deaths and summarizes potential strategies to prevent future deaths.

MedicalResearch.com: What are the main findings? 

Response: The new analysis finds that nearly 31 percent of pregnancy-related deaths happen during pregnancy, 36 percent happen during delivery or the week after, and 33 percent happen one week to one year after delivery. However, data from 13 state maternal mortality review committees (MMRCs) found that three in five deaths could be prevented, no matter when they occur. 

The research also showed that leading causes of death differed throughout pregnancy and after delivery:

• Heart disease and stroke caused more than 1 in 3 deaths overall.
• Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), caused most deaths at delivery.
• In the week after delivery, severe bleeding, high blood pressure, and infection were most common.
• Cardiomyopathy (weakened heart muscle) was the leading cause of deaths 1 week to 1 year after delivery.

Finally, the data confirm persistent racial disparities: Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women. However, the new analysis also found that most deaths were preventable, regardless of race or ethnicity.

MedicalResearch.com: What should readers take away from your report? 

Response: While maternal deaths are relatively rare and most pregnancies progress safely, every death is tragic, especially because most are preventable. According to our research, every death reflects a web of missed opportunities; each death was associated with an average of 4 contributing factors, such as issues related to access to care, missed or delayed diagnoses, and not recognizing warning signs. To prevent maternal deaths, we must address prevention opportunities every step of the way – ensuring women receive high quality and timely care during pregnancy, at delivery and up to a year afterward and we all have a role to play:

• Providers can help patients manage chronic conditions and have ongoing conversations about the warning signs of complications.
• Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among healthcare providers. They can also work to improve delivery of quality care before, during, and after pregnancy and standardize approaches for responding to obstetric emergencies.
• States and communities can address social determinants of health, including providing access to housing and transportation. They can develop policies to ensure high-risk women are delivered at hospitals with specialized health care providers and equipment — a concept called “risk-appropriate care.” And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.
• Women and their families can know and communicate about the warning symptoms of complications and note their recent pregnancy history any time they receive medical care in the year after delivery.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Currently, approximately 40 states and 2 cities has a maternal mortality review committee. However, we only reported data from 13 states that agreed to share their information. Having more and better data from MMRCs could help identify additional opportunities for prevention.

Additionally, while this research underscored continued racial disparities and found that preventability doesn’t vary by race, we need a better understanding of why disparities persist. Future research could shed light on that important piece of the puzzle.

No relevant disclosures to add.

Citation:

Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429. DOI: http://dx.doi.org/10.15585/mmwr.mm6818e1  

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Last Updated on May 17, 2019 by Marie Benz MD FAAD