The Fight to End Pregnancy-Related Deaths
Recent years have seen significant advances in preventing deaths from pregnancy-related complications. A Centers for Disease Control and Prevention (CDC) report estimated 1,459 deaths due to pregnancy-related complications in the US from 1987–1990, and identified women over 35 years old, people of black descent, and those without prenatal care as three groups with disproportionately increased risk. In May 2019, a study was conducted to investigate the circumstances surrounding the 700 women who die annually from pregnancy complications in the US. The study focused on the timing of death in relation to pregnancy, cause of death, and preventability of pregnancy-related deaths.
Pregnancy-related deaths, defined as deaths directly attributable to pregnancy, were established in a timeframe starting from during pregnancy to a year after delivery. The national Pregnancy Mortality Surveillance System, established to determine causes and risk factors of pregnancy-related deaths, collects data from death certificates that link maternal death to live birth or fetal death. Data from 2011–2015 was then further evaluated to determine the cause of death and timing. The data also analyzed demographic factors, such as age, race, education, and marital status, to account for disparities.
The majority of pregnancy-related deaths were found to be caused by cardiomyopathy, where difficulty in circulating blood can lead to heart failure, along with other cardiovascular issues. However, the leading cause of death differed depending on when the death happened. About 48% of deaths occur during pregnancy or delivery, and 52% of deaths occur up to a year after delivery. The leading causes of death during pregnancy and delivery included thrombotic pulmonary and amniotic fluid embolisms. Following delivery, leading causes of death included hypertensive disorders of pregnancy, infection, and cardiomyopathy.
Based on data from 13 states also collected as part of the study, 60% of pregnancy-related deaths were identified as preventable. Systemic problems, including inadequate access to care and limited experience of health staff dealing with pregnancy emergencies, contributed to these preventable deaths. On a case-by-case basis, lack of transportation to healthcare facilities and delayed diagnosis by the provider along with other factors also impacted the pregnancy outcome.
Pregnancy-related deaths, defined as deaths directly attributable to pregnancy, were established in a timeframe starting from during pregnancy to a year after delivery. The national Pregnancy Mortality Surveillance System, established to determine causes and risk factors of pregnancy-related deaths, collects data from death certificates that link maternal death to live birth or fetal death. Data from 2011–2015 was then further evaluated to determine the cause of death and timing. The data also analyzed demographic factors, such as age, race, education, and marital status, to account for disparities.
The majority of pregnancy-related deaths were found to be caused by cardiomyopathy, where difficulty in circulating blood can lead to heart failure, along with other cardiovascular issues. However, the leading cause of death differed depending on when the death happened. About 48% of deaths occur during pregnancy or delivery, and 52% of deaths occur up to a year after delivery. The leading causes of death during pregnancy and delivery included thrombotic pulmonary and amniotic fluid embolisms. Following delivery, leading causes of death included hypertensive disorders of pregnancy, infection, and cardiomyopathy.
Based on data from 13 states also collected as part of the study, 60% of pregnancy-related deaths were identified as preventable. Systemic problems, including inadequate access to care and limited experience of health staff dealing with pregnancy emergencies, contributed to these preventable deaths. On a case-by-case basis, lack of transportation to healthcare facilities and delayed diagnosis by the provider along with other factors also impacted the pregnancy outcome.
The CDC recommends expanding Medicare in order to ensure access to medical help during and after pregnancy.
Image Source: DarkoStojanovic
In order to address preventable deaths, the CDC recommends prevention strategies such as expanding clinical working hours to increase access, providing emergency training to increase preparedness, and creating patient education materials to ensure knowledge of warning signs. More significantly, the CDC also recommends that Medicaid, the government insurance plan for low-income Americans, should be expanded to include one year of post-delivery care due to the prevalence of pregnancy-related deaths in that time period.
In all, this study shows that the many contributing factors, including systemic factors like limited access to care, demonstrate a need to reduce the number of preventable pregnancy-related deaths. The findings also address the racial disparities of pregnancy-related deaths. For instance, and as in previous decades, black women continue to be three times more likely to die from pregnancy than white women. In order to address these differences, further study is needed into what contributing factors disproportionately affect specific groups, in order to create a healthcare system that provides equal quality of care.
In all, this study shows that the many contributing factors, including systemic factors like limited access to care, demonstrate a need to reduce the number of preventable pregnancy-related deaths. The findings also address the racial disparities of pregnancy-related deaths. For instance, and as in previous decades, black women continue to be three times more likely to die from pregnancy than white women. In order to address these differences, further study is needed into what contributing factors disproportionately affect specific groups, in order to create a healthcare system that provides equal quality of care.
Featured Image Source: Pixabay
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