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An Alarming Trend in Maternal Health

by Maryalice Yakutchik

Maternal death is dropping in many countries—globally the number of women dying from pregnancy-related causes has fallen from 376,000 in 1990 to 293,000 last year. However, the rate in the U.S. doubled during the last decade, and the incidence of near-death has also spiked.

Maternal mortality has not declined in the U.S. for a quarter century, according to Andreea Creanga, MD, PhD ’09, who leads the CDC’s Pregnancy Mortality Surveillance System.

“It’s an alarming statistic,” she says.

Creanga’s job involves collecting vital statistics data from all 50 states and then painstakingly analyzing each individual case of maternal death. About 650 women die annually nationwide; about a third of these deaths are preventable.

Generating a clear and up-to-date picture of the problem at a population level is no easy feat. The death rate rise in the U.S. can, at least in part, be attributed to improvement in how maternal deaths are identified, Creanga notes.

But that’s hardly the whole story.

Among the significant risk factors for maternal death is a mother’s age; the number of U.S. women delaying childbearing has increased in recent years. Obesity is another risk factor. So is having hypertension and diabetes, both of which contribute to high-risk pregnancies. Being foreign-born as opposed to U.S.-born is a risk factor. So is race. Black women have a three- to four-times higher risk of maternal mortality, but no clear evidence exists to explain the disparity.

Ascertaining the true nature of the problem can be tricky given the relatively small number of cases of maternal death, Creanga explains. “We need larger numbers to be able to draw reliable conclusions.”

The complexity of maternal death at the population level is heightened by the fact that it’s a moving target, Creanga explains. “Things are changing every year, and we want to know about these changes.”

To help provide an all-important context for understanding what’s behind the trend, Creanga has co-authored research that measures the incidence of maternal near-death cases to combine with mortality data.

One notable new finding: Traditionally, hypertension, hemorrhage and embolism were the leading causes of maternal mortality. Lately, there’s been a shift to cardiovascular conditions as the main contributor to maternal death, Creanga notes.

“The more we know about risk factors and causes of deaths, the more we can do something to prevent maternal deaths,” she says.

Her office is now collaborating with a wide assortment of clinical and professional partners on an initiative that focuses on “patient safety bundles”—standardized sets of evidence-based guidelines, practices and tools that health care practitioners and hospitals can employ to improve outcomes. The first bundle involves a hemorrhage management protocol to prevent death. “We are now putting together bundles for hypertension and embolism,” Creanga says. “Going forward, we’ll be creating bundles that address obesity and cardiovascular disease.”

Her work can be very sad, Creanga says, especially recreating scenarios involving the death of young mothers. “But it’s what we have to do. No woman should be dying from pregnancy-related complications in the U.S. in 2014. And yet, many are dying every year. We need to know why.”