Each year, roughly 700 women in the U.S. die during pregnancy, childbirth, or after giving birth — and the majority of those deaths are preventable, according to a new analysis.
Heart disease and stroke were the leading cause of pregnancy-related deaths each year from 2011 to 2017, researchers at the Centers for Disease Control and Prevention reported Tuesday. The report also found that black women and American Indian and Alaska Native women were far more likely than white women to die of pregnancy-related problems.
“While maternal deaths are relatively rare, every death is tragic and it often represents a web of missed opportunities,” said Dr. Nicole Davis, an epidemiologist at the CDC and a co-author of the new report.
The analysis was based on two data sources: national pregnancy mortality data from 2011 to 2015 and data from 2013 to 2017 that was collected by maternal mortality review committees in 13 states.
The researchers found that pregnancy-related deaths can happen across a large span of time, from the period of pregnancy itself to a year after a woman has given birth. More than 31 percent of deaths were during pregnancy, 17 percent on the day of delivery, 19 percent in the week after birth, and 33 percent anytime between a week and a year after birth.
The leading causes of death varied, depending on the time of death. On the day of delivery, acute emergencies such as hemorrhage and amniotic fluid embolisms were the most common cause of death. Hemorrhage was also the leading cause of death in the week after birth, while infection and other cardiovascular issues were most frequently the cause of death one week and six weeks after delivery. Between six weeks and a year after delivery, pregnancy-related heart disease contributed to the greatest number of deaths.
“It’s really important for us to care for our pregnant and postpartum women during pregnancy and even up to one year after delivery,” said Dr. Emily Petersen, a medical officer at the CDC and the paper’s lead author.
There were significant disparities in the death rate for different racial, ethnic, and age groups. Overall, there were 17 pregnancy-related deaths for every 100,000 live births in the U.S. each year. Among white women specifically, there were 13 deaths per 100,000 live births. But among black women, there were nearly 43 deaths, and among American Indian and Alaska Native women, nearly 33 deaths. Pregnancy-related deaths were also far more common among women over age 35 and somewhat more frequent among women who weren’t married.
Using the state data, the authors found that roughly 60 percent of pregnancy-related deaths were preventable. They considered a death to be preventable if a reasonable change — whether on the patient, provider, or health facility level — meant it might have been avoidable.
There weren’t significant racial or ethnic disparities in the data on preventable deaths. And many deaths were preventable regardless of the time they occurred, whether that was during pregnancy or months after birth.
The authors say that having a better understanding of what’s driving pregnancy-related deaths can help communities, hospitals, and health care providers do more to prevent them. State maternal mortality committees have identified a range of strategies to curb deaths among pregnant and postpartum women. Among them: increasing the number of providers who accept Medicaid to improve access to prenatal care, educating providers on cardiac conditions in pregnant and postpartum women, and strengthening the training for emergency room staff who care for women experiencing complications.
Experts say there’s also a need for better patient education so women and their families know the warning signs of pregnancy-related issues.
“The reality of the issue of pregnancy-related death is there isn’t one single solution,” Davis said. “Everyone has a role to play, from providers and patients to states and communities.”