May 14, 2019
Women are dying during pregnancy and childbirth at alarming rates—some up to a year after delivery, according to a new report by the U.S. Centers for Disease Control and Prevention (CDC).
The report reveals more than 50,000 women suffer serious complications during pregnancy and childbirth, and 700 of them die annually. For every five mothers dying in the United States from pregnancy and childbirth, the agency's analysis shows that three could have been saved with improved medical care. In other words, more than half of maternal deaths are preventable in America.
"These are women in their prime who leave loved ones behind often stunned at what has happened," CDC principal deputy director Anne Schuchat, M.D., noted in a media briefing.
Globally, maternal mortality fell about 44 percent between 1990 and 2015, according to the World Health Organization. But the U.S. bucks this healthy trend: women die in about 17 out of every 100,000 U.S. births each year, up from 12 per 100,000 a quarter century ago. It remains the nation with the highest maternal mortality rate in the developed world.
The CDC's report analyzed national data on pregnancy-related deaths between 2011 and 2015, as well as detailed data from 13 states collected between 2013 and 2017. The CDC defines "pregnancy-related death" as one occurring within one year of the pregnancy's end. The report found that approximately one-third of maternal deaths happened during pregnancy, one-third were during or within a week of birth, and the remainder occurred up to a year later.
Causes could be a chain of events initiated by pregnancy, a related complication, or a pregnancy-induced aggravation of an unrelated medical condition. Researchers observed that 1 in 3 deaths were caused by heart disease and stroke, and infections and severe blood loss were listed as additional leading causes.
Dena Goffman, M.D., the chief of obstetrics at NewYork-Presbyterian/Columbia University Irving Medical Center, notes that as the number of high-risk patients grows, so does the demand for specialized treatment in reducing maternal death rates.
"We're actively working on our ability to improve care for women with complex medical-surgical risks," said Dr. Goffman, also the associate chief quality officer for NewYork-Presbyterian's Hospital Obstetrics. "These women are becoming pregnant more often, and we've developed a model for collaborative patient centers and multidisciplinary care." That includes The Mothers Center, an outpatient unit in New York with specific programs, including ones for mental health, gestational diabetes, anesthesia consultation, and placenta accreta spectrum disorders. "This is providing multidisciplinary care in one place for women who need all those various collaborative specialties involved," adds Dr. Goffman.
The CDC data confirmed that deaths were associated with several factors related to prenatal care. In some cases, women died because they lacked access to adequate health care, leading to delayed or missed diagnoses of critical medical complications. The report detailed women and health care providers appearing to lack knowledge about the warning signs of a high-risk pregnancy. Profound racial disparities were also noted: African American, American Indian, and Alaska Native women were nearly three times as likely as white women to die from a pregnancy-related cause.
"From a preconception standpoint, it is so important to optimize underlying medical conditions before pregnancy as these problems can significantly worsen during pregnancy," said Gwyneth Bryant, M.D., an ob-gyn at Northwestern Medicine Prentice Women's Hospital in Chicago. "Within the hospital, numerous protocols have been instituted to allow for early recognition and immediate action in the setting of emergencies, such as postpartum hemorrhage or hypertensive emergencies. Preventative measures have been instituted to decrease risk of blood clots. Given that risks go well beyond the time of delivery, benefit has been noted with close postpartum follow-up."
Dr. Bryant also said the CDC's data—while disappointing—doesn't come as a surprise, and more needs to be done.
“Society as a whole also needs to recognize its role in the poor statistics we see in this country. Access to adequate contraception so that pregnancies are planned, access to quality maternity care and ongoing postpartum care is absolutely necessary to improve these outcomes,” Dr. Bryant said. “The United States is one of the only developed countries where no mandate exists for paid maternity leave. The lack of support for new mothers in our society cannot be overlooked as a contributor to this problem."