Pregnancy-related deaths can happen as long as up to a year after a woman gives birth but most of these deaths are preventable, according to a new CDC Morbidity and Mortality Weekly Report(www.cdc.gov) and related Vital Signs report.(www.cdc.gov)
Of the approximately 700 pregnancy-related deaths that occur every year in the United States for which timing is known, the agency said 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days one to six postpartum, 21.4% on days seven to 42 postpartum, and 11.7% on days 43-365 postpartum.
Leading causes of death varied by timing relative to the end of pregnancy and included cardiovascular conditions (more than 33%), infection (12.5%) and obstetric hemorrhage (11.2%).
For the report, the CDC analyzed data from its national Pregnancy Mortality Surveillance System for 2011-2015. Pregnancy-related mortality ratios were calculated overall and by sociodemographic characteristics. The agency also calculated the distribution of pregnancy-related deaths by timing relative to the end of pregnancy and by leading causes of death.
Additionally, the CDC analyzed data on pregnancy-related deaths during 2013-2017 from 13 state maternal mortality review committees for preventability, factors that contributed to pregnancy-related deaths and MMRC-identified prevention strategies to address contributing factors.
- Sixty percent of pregnancy-related deaths for which timing was known from 2011-2015 were preventable, according to a new CDC Morbidity and Mortality Weekly Report.
- Of the approximately 700 pregnancy-related deaths that occur every year in the United States for which timing is known, the agency said 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days one to six postpartum, 21.4% on days seven to 42 postpartum, and 11.7% on days 43-365 postpartum.
- Leading causes of death varied by timing relative to the end of pregnancy and included cardiovascular conditions (more than 33%), infection (12.5%) and obstetric hemorrhage (11.2%).
About 60% of pregnancy-related deaths from state MMRCs were determined to be preventable and preventability did not differ significantly by race/ethnicity or timing of death.
"Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our nation's highest priorities," said CDC Director Robert Redfield, M.D., in a news release.(www.cdc.gov) "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 preventive care that can and does save lives."
The report noted that from 2011-2015, the national pregnancy-related mortality ratio was 17.2 per 100,000 live births.
Non-Hispanic black women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), which was 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white women (13), the CDC found.
State MMRCs identified an average of three to four contributing factors per pregnancy-related death, the MMWR report said.
Contributing factors were thematically coded as community factors (e.g., unstable housing and limited access to transportation), health facility factors (e.g., limited experience with obstetric emergencies and lack of appropriate personnel or services), patient factors (e.g., lack of knowledge of warning signs and nonadherence to medical regimens), provider factors (e.g., missed or delayed diagnosis and lack of continuity of care) and system-level factors (e.g., inadequate access to care and poor case coordination).
Preventing Maternal Deaths
The MMWR report said prevention strategies identified by state MMRCs included addressing community factors by expanding clinical office hours and the number of practices that accept Medicaid, prioritizing pregnant and postpartum women for temporary housing programs, and improving access to transportation.
To better prevent maternal deaths, the CDC said health care facilities could also implement obstetric emergency protocols and simulation training, provide telemedicine for facilities that do not have on-site obstetric expertise and implement systems to foster communication among multiple physicians.
And although patient-level contributing factors were commonly identified, prevention strategies to mitigate these factors often relied on physicians and health systems, the report said.
"For example, prevention strategies to address patient-level factors included improving patient education materials and providing home health and patient support services," the CDC said.
Physician-level prevention strategies included offering physician education to reduce missed or delayed diagnoses, implementing a maternal early warning system and improving handoff communication between obstetricians and other physicians.
Finally, the MMWR report said MMRC-identified prevention strategies addressing health system-level factors included developing policies to ensure that women deliver at a health facility with an appropriate level of maternal care and extending Medicaid coverage for pregnant women to include one year of postpartum care.
"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," Wanda Barfield, M.D., M.P.H., director of the Division of Reproductive Health in the CDC's National Center for Chronic Disease Prevention and Health Promotion, said in the release. "By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives."
AAFP Maternal Mortality Task Force
The AAFP is working with partners to address the maternal mortality problem.
This past weekend, AAFP President John Cullen, M.D., of Valdez, Alaska, was a featured speaker during the March for Moms(www.marchformoms.org) rally on the National Mall in Washington, D.C., to raise awareness of the issue.
But the March for Moms event was just one piece of the Academy's strategy on this issue.
Cullen told AAFP News that representatives from the AAFP met March 26 in Washington with representatives from the American College of Obstetricians and Gynecologists and the National Rural Health Association.
Both organizations are participating in the AAFP's maternal mortality task force, which was created at the direction of a substitute resolution adopted by the 2018 Congress of Delegates. It is expected to report back to the COD when it meets Sept. 23-25 in Philadelphia.
AAFP Director and task force chair Tochi Iroku-Malize, M.D., M.P.H., M.B.A., told AAFP News previously that the group has four primary objectives:
- Evaluate evidence-based methods to decrease maternal mortality.
- Review methods to increase recognition of implicit bias and reduce disparities in maternal morbidity and mortality.
- Develop strategies to help improve resident education and support practicing family physicians providing full-scope reproductive and maternity care.
- Address the growing loss of rural maternity services nationwide.
The task force includes AAFP members and also has representation from other family medicine organizations -- namely, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the Society of Teachers of Family Medicine. In addition to these groups, the American Hospital Association is participating, and the task force may expand further to broaden its reach.
Related AAFP News Coverage
Fresh Perspectives: Our Maternal Mortality Rate Is Shameful
More From AAFP
American Family Physician: AFP By Topic: Prenatal Care