EXECUTIVE SUMMARY

A pregnancy-related death can happen during pregnancy, at delivery, and even up to one year after. National health experts are now sounding out what is necessary to reduce maternal deaths in light of new research indicating that about three out of every five such deaths are preventable.

• According to the analysis, of the 700 pregnancy-related deaths that occur each year in the United States, about 31% happen during pregnancy, 36% occur during delivery or the week after, and 33% are recorded one week to one year after delivery.

• Analysis findings suggest that leading causes of death differed throughout pregnancy and after delivery. Overall, heart disease and stroke caused more than one in three deaths.


Pregnancy-related death can occur during pregnancy, delivery, and even up to one year after. National health experts are outlining ways to reduce maternal deaths in light of new research indicating that about three out of every five such deaths are preventable.1

The findings stem from a CDC analysis of 2011-2015 national data on pregnancy mortality and 2013-2017 detailed data from 13 state maternal mortality review committees (MMRCs). According to the analysis, of the 700 pregnancy-related deaths that occur each year in the United States, about 31% happen during pregnancy, 36% occur during delivery or the week after, and 33% are recorded one week to one year after delivery.

The study’s findings suggest that leading causes of death differed throughout pregnancy and after delivery. Overall, heart disease and stroke caused one in three deaths. At delivery, obstetric emergencies such as severe bleeding and amniotic fluid embolism were found as the cause of most deaths.

Severe bleeding, high blood pressure, and infection were the most common causes in the week after delivery, while cardiomyopathy was the leading cause of deaths one week to one year after delivery.1

There are racial disparities, according to the analysis: black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women. However, most deaths were preventable, regardless of race or ethnicity, the report authors concluded.

“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,” notes Wanda Barfield, MD, MPH, FAAP, director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention and Health Promotion. “By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives.”

Changes on State and National Levels

Beginning in fall 2019, through CDC’s new “Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees” funding opportunity, the agency will provide financial backing for up to as many as 25 committees across the country to collect data that can aid in eliminating preventable maternal deaths. The CDC currently funds the efforts of 13 state perinatal quality collaboratives, which are state-based initiatives that focus on improving the quality of care for mothers and babies.

The committees will serve as an important link in determining care, said Barfield in a press telebriefing on the subject. The committees, which are multidisciplinary groups comprised of state or local experts, review maternal deaths and circumstances to better understand how to prevent future deaths, said Barfield.

“These committees examine all available data sources, including medical records and social services records, to determine the factors that contributed to the death, determine preventability, and suggest specific prevention strategies,” stated Barfield. “This is a critical level of information we cannot get from reviewing just death certificates alone, and this is why MMRCs are so important to our understanding of this issue.”

The committees have suggested prevention methods to address contributing factors at the healthcare provider, facility, and system levels, as well as at the patient and community levels, said Barfield. For instance, at the healthcare facility and systems levels, work remains to standardize responses to obstetric emergencies to make sure women receive recommended care when hemorrhaging or experiencing infection.

Another strategy is to develop policies to ensure high-risk women are delivered at hospitals with specialized healthcare providers and equipment. Also, cross-communication and collaboration among providers must be encouraged, said Barfield.

How can clinicians reduce pregnancy-related deaths? By helping patients manage chronic conditions, communicating about warning signs, and using tools to flag warning signs early. Educate patients about warning symptoms of complications, and what to do when they occur. (The federal Office on Women’s Health offers links to free, reproducible fact sheets on many conditions at: https://bit.ly/2PdEies.)

During delivery, help standardize patient care by seeing that high-risk women are delivered at hospitals with specialized providers and equipment. After delivery, continue to communicate with patients about warning signs and encourage prompt follow-up care.

“Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our nation’s highest priorities,” said CDC Director Robert Redfield, MD. “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.”

REFERENCE

  1. 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.