Hundreds of women die each year from pregnancy issues. Most of the deaths could be prevented
The U.S. has the highest rate of pregnancy-related mortality among developed nations. Figures suggest that half of those deaths may have been prevented. (Video: Luis Velarde/Photo: John Parks/The Washington Post)
Hundreds of women die preventable deaths of complications from pregnancy each year in the United States, even weeks or months after childbirth, according to a report from the Centers for Disease Control and Prevention. Health experts say recognizing contributing factors such as racial disparities and working toward solutions are key in saving lives.
The CDC confirmed in a report released Tuesday that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60 percent of the cases, the deaths could have been prevented, in part, with proper medical intervention, as well as better access to it, the researchers noted.
“The bottom line is that too many women are dying largely preventable deaths associated with their pregnancies,” Anne Schuchat, CDC’s principal deputy director, said Tuesday during a news call. “We have the means to identify and close gaps in the care they receive.”
“We can’t prevent every one of these tragedies,” Schuchat added, “but we can and should do more.”
CDC researchers analyzed national data between 2011 and 2015 from its Pregnancy Mortality Surveillance System, as well as data between 2013 and 2017 from the maternal mortality review committees in 13 states. The findings confirmed that there were more than 3,400 pregnancy-related deaths over a five-year period in the United States.
Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and chief obstetrician at New York Presbyterian Hospital, said the new CDC report confirms what medical professionals have been seeing in studies in the past several years, but that the details in the data are key to understanding it.
“Once you can start to understand the causes of these deaths and the contributing factors, you can start to create meaningful interventions,” she said in an email to The Washington Post.
“Preventability is very important and puts the responsibility squarely on providers, public health groups and hospitals.”
The CDC researchers noted in the report that one-third of the women studied died during pregnancy and that another third died during childbirth or within the week after it.
But another third died weeks or months after delivery, up to a year after their babies were born.
For the women who died more than a week postpartum, 21 percent died seven to 42 days after childbirth, and nearly 12 percent died 43 to 365 days after childbirth.
The leading cause of death was cardiovascular conditions, such as heart disease and stroke, which accounted for 33 percent of pregnancy-related deaths. Infections accounted for nearly 13 percent, and obstetric hemorrhage accounted for 11 percent. A cause of death could not be determined in nearly 7 percent of the cases, according to the report.
The researchers said there were many contributing factors, including access to proper medical care, missed or delayed diagnoses, or warning signs that went unnoticed.
But the researchers not only looked at why the women died, but also who the women were — confirming racial disparities in maternal mortality across the United States. According to the report, black and American Indian/Alaska Native women were about three times as likely as white women to die of pregnancy-related issues.
Emily Petersen, co-author of the report and medical officer in the CDC’s Division of Reproductive Health, said researchers have known about the racial disparities between black and white women concerning maternal mortality. But she noted that although some disparities have been attributed to challenges with access to care, “we don’t think this explains everything.”
“The reason for this higher prevalence is still being explored and one emergent theory is the effect of weathering or early aging of the body due to chronic stress related to structural racism or systemic racism and its impact on health. There’s also a growing body of research on the role of structural racism and implicit bias in health care and its impact on patient care and outcomes,” she said, noting that many hospitals have already started to implement training for their staff members.
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Experts say there’s no simple solution.
The researchers said in the report that no single intervention is enough, suggesting a multipronged approach to reduce pregnancy-related deaths by “reviewing and learning from each death, improving women’s health, and reducing social inequities across the life span, as well as ensuring quality care for pregnant and postpartum women.”
Riley, the chair of obstetrics and gynecology at Weill Cornell Medicine, said medical professionals “need to focus our efforts on heart disease prevention, diagnosis and treatment — many would not expect this to occur in young women!”
