Three out of five pregnancy-related deaths in the U.S. are preventable, and federal health officials want providers to keep a watchful eye for factors that could lead to maternal mortality.
Approximately 700 women in the U.S. die each year due to pregnancy- or birth-related complications up to a year after delivery, the Centers for Disease Control and Prevention said in a new report on Tuesday.
From 2011 to 2015, nearly 31% of maternal deaths happened during pregnancy compared with 36% that occurred on the day of delivery and up to one week after, while 33% happened one week to one year after delivery.
Heart disease and stroke accounted for a third of pregnancy-related deaths overall. But obstetric emergencies, like severe bleeding and amniotic fluid embolism caused the most deaths at time of delivery. Severe bleeding, high blood pressure and infections were the most common causes of death in the week after delivery while cardiomyopathy, which is when the heart swells with fluid causing it to pump less efficiently, caused the most deaths from one week through the first year postpartum.
"Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our nation's highest priorities," CDC Director Dr. Robert Redfield said in a released statement. "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 U.S. has seen its maternal mortality rate rise for decades while most other countries have experienced declines. A 2017 study published in the Lancet found the U.S. had a maternal mortality rate of 26.4 deaths for every 100,000 live births in 2015 compared with 7.3 deaths in Canada, 7.8 in France, and 8.8 deaths in England.
While the CDC report estimated a lower overall rate at 17.2 pregnancy-related deaths for every 100,000 live births, there were huge disparities found based on race. Black women had the highest rate of maternal mortality at 42.8 deaths for every 100,000 live births, compared with 32.5 deaths among American Indian and Alaskan Natives and 13 deaths among white women. Asian women had a maternal mortality rate of 14.2 deaths for every 100,000 live births, while Hispanic women had the lowest rate of any ethnic and racial group at 11.4 deaths.
Dr. Lisa Hollier, immediate past president for the American College of Obstetricians and Gynecologists, said the disparities in outcomes among racial and ethnic groups had multiple contributing factors. But the high number of preventable deaths offers an opportunity for healthcare providers to make efforts to reduce their contributing role.
Misdiagnosis and delays in treatment were among some of the leading contributing factors identified by the report. A lack of access to appropriate care as well as a lack of knowledge among patients and providers about the warning signs of possible complications were also associated with higher risks of death.
ACOG has been developing interventions and guidance to address the potential care gaps that could raise the risk of maternal mortality through its Alliance for Innovation on Maternal Health initiative.
Hollier said the program successfully reduced complications in hospitals that implemented the guidance. The report recommended states and communities develop policies to ensure women with high risks of complications delivered their babies at hospitals with specialized healthcare providers and equipment.
"These multiple factors suggest we need multifactorial solutions to prevent maternal deaths," Hollier said.
