May 07, 2019
Nearly 700 women die each year in the United States from complications of pregnancy and 60% of these deaths can be prevented, federal health officials at the Centers for Disease Control and Prevention (CDC) said in a CDC Vital Signs report released today.
"The bottom line is that too many women are dying largely preventable deaths associated with their pregnancies. We have the means to identify and close gaps in the care they receive. We can't prevent every one of these tragedies but we can and should do more," CDC Principal Deputy Director Anne Schuchat, MD, said during a press briefing.
"Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our Nation's highest priorities," CDC Director Robert R. Redfield, MD, added in a news release. "Though most pregnancies progress safely, I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives."
The CDC defines pregnancy-related death as the death of a woman during pregnancy, at delivery, or up to a year after delivery from a pregnancy complication, which is a chain of events initiated by pregnancy or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
During 2011-2015, a total of 3410 pregnancy-related deaths occurred in the United States, a rate of 17.2 per 100,000 live births, according to a Morbidity and Mortality Weekly Report (MMWR).
The timing of death was known for 2990 (88%) of pregnancy-related deaths; 31.3% occurred during pregnancy, 35.5% during delivery or the week after delivery, and 33.1% 1 week to 1 year postpartum.
The leading causes of death differ when women die during pregnancy versus after delivery. Heart disease and stroke caused 34% of pregnancy-related deaths overall. Obstetric emergencies, such as severe bleeding and amniotic fluid embolism, caused most deaths at the time of delivery. In the week after delivery, severe bleeding, high blood pressure, and infection were most common. Cardiomyopathy caused the largest proportion of deaths 6 weeks to 1 year postpartum.
The latest data confirm persistent racial disparities in pregnancy-related deaths in the United States. Black and American Indian/Alaska Native women are about three times as likely to die from a pregnancy-related cause as white women.
A Call to Action
"Alarmingly," Schuchat said, data from state maternal mortality review committees (MMRCs) shows that about three in five pregnancy-related deaths could potentially be prevented, regardless of race or ethnicity.
Contributing factors to pregnancy-related deaths identified by 13 state MMRCs include community factors (eg, unstable housing and limited access to transportation), health facility factors (eg, limited experience with obstetric emergencies and lack of appropriate personnel or services), patient factors (eg, lack of knowledge of warning signs and nonadherence to medical regimens), provider factors (eg, missed or delayed diagnosis and lack of continuity of care), and system-level factors (eg, inadequate access to care and poor case coordination).
Most of the pregnancy-related deaths, regardless of when they occurred, could have been prevented by addressing these community, health facility, patient, provider, and system level factors, the CDC says.
"Our new analysis underscores the need for access to quality services, risk awareness, and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths. By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives," Wanda Barfield, MD, MPH, director of the CDC's Division of Reproductive Health and assistant surgeon general in the US Public Health Service, said in the release.
The CDC encourages providers to help pregnant women manage chronic conditions and have ongoing conversations about the warning signs of complications. They encourage hospitals and health systems to communicate and collaborate with providers and 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 healthcare providers and equipment. And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.
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SOURCE: Medscape, May 07, 2019. MMWR. Published online May 7, 2019.