Pregnancy-Related Deaths in the United States Has Increased

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Researchers from the US Centers for Disease Control and Prevention (CDC) have published a study which found the United States pregnancy-related deaths has increased.

Dr. Cynthia J. Berg, of the CDC's division of reproductive health, and colleagues have published the results of their study in the December 2010 issue of the journal Obstetrics and Gynecology.

Berg and her colleagues used data reported to the Pregnancy Mortality Surveillance System from the 50 states, New York City, and Washington, DC. between 1998 and 2005. There were 4,693 pregnancy-related deaths, defined as the death of the woman during or within 1 year of pregnancy and accredited to a pregnancy complication.

The researchers identified causes of death and factors associated with them. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were then calculated.

The pregnancy-related mortality ratio for the 8-year period (1998 to 2005) was 14.5 per 100,000 live births, which is higher than any period in the previous 20 years. It is nearly double the numbers from 1986, when the pregnancy-related death rate was 7.4 per 100,000 live births.

The researchers also noted African-American women continued to have a three- to four-fold higher risk of pregnancy-related death.

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There were seven main causes of death—hemorrhage, thrombotic pulmonary embolism, infection, hypertensive disorders of pregnancy, cardiomyopathy, cardiovascular conditions, and noncardiovascular medical conditions—each contributed 10% to 13% of deaths.

The proportion of deaths attributable to hemorrhage and hypertensive disorders declined from previous years. Hemorrhaging accounted for nearly 30% of pregnancy-related deaths between 1987 and 1990, but decreased to 12% between 1998 and 2005.

High blood pressure disorders, mainly pre-eclampsia, also accounted for 18% of deaths between 1987 and 1990, but decreased to 12% between 1998 and 2005.

The researchers noted the proportion of deaths accredited to heart problems more than doubled. Between 1998 and 2005 almost 12% were attributed to enlargement of the heart compared to about 5% between 1987 and 1990. During 1998 and 2005 there were about 12% of pregnancy-related deaths attributed to cardiovascular complications compared to less than 5% during 1987 to 1990.

The reasons for the reported increase in pregnancy-related mortality are unclear. Possible factors include an increase in the risk of women dying, changed coding with the International Classification of Diseases, 10th Revision, and the addition by states of pregnancy check boxes to the death certificate.

More women of childbearing age today are obese or have chronic health problems like high blood pressure and diabetes than women of years past.

Good prenatal care is very important. All women should try to have a pre-pregnancy visit with their ob-gyn.

Sources
Pregnancy-Related Mortality in the United States, 1998 to 2005; Berg, Cynthia J.; Callaghan, William M.; Syverson, Carla; Henderson, Zsakeba; Obstetrics & Gynecology. 116(6):1302-1309, December 2010; doi: 10.1097/AOG.0b013e3181fdfb11

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