Preventing Pregnancy-Related Deaths
A new report from the Centers for Disease Control and Prevention (CDC) has found that about 700 pregnancy-related deaths occur each year in the United States, but most are preventable with appropriate prenatal and postpartum care. Sadly, more women in the U.S. die of pregnancy complications than in other developed nations. For the report, published May 7, 2019, the authors reviewed national data on pregnancy-related deaths between 2011 and 2015 as well as data compiled from 2013 to 2017 by thirteen state maternal mortality review committees.
According to the CDC, pregnancy-related deaths can occur not only during pregnancy but also up to one year after a woman has given birth. The data showed that roughly one-third of maternal deaths occur during pregnancy, one-third during delivery or the week following delivery, and one-third between one week to one year after the baby is born.
Maternal deaths can result from complications or events initiated by pregnancy, as well as from pre-existing conditions made worse by the normal changes to women’s bodies that occur during pregnancy. Overall, the most common causes of pregnancy-related deaths are heart disease and stroke, with heart disease accounting for more than a quarter of deaths. Other leading causes of maternal deaths depend on the time frame:
- Severe bleeding, infection and amniotic fluid entering the bloodstream cause most deaths during delivery.
- Severe bleeding, high blood pressure and infection cause the most deaths the week after delivery.
- A weakened heart (cardiomyopathy) is the most common cause of deaths between one week to one year after delivery.
Many of the reported pregnancy-related deaths were associated with contributing factors, including:
- Lack of access to appropriate and high-quality care for some women before and after pregnancy and during delivery
- Delayed or missed diagnoses
- Not enough information among both mothers and their healthcare practitioners about warning signs of serious complications
The CDC report also found that racial disparities are persistent and a key factor in many of the deaths. African American, Native American and Alaskan Native women were about three times as likely to die from a pregnancy-related cause as white women. But most maternal deaths are preventable regardless of race or ethnicity. With appropriate care and timely treatment, three out of five pregnancy-related deaths could be prevented, according to the CDC report.
“Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our nation’s highest priorities,” said CDC Director Robert R. Redfield, M.D. “Though most pregnancies progress safely, I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives.”
Pregnancy and heart disease
Just a few days before the CDC report, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines for treating heart disease during and after pregnancy. Concerned about the high rate of heart disease-related deaths among pregnant and postpartum women, and especially about high rates of such deaths in women of color, ACOG encouraged healthcare practitioners to begin using the new guidelines immediately.
Every pregnancy calls on the heart to do more, which is why regular prenatal visits for blood pressure monitoring and other tests are important. Among the stresses that pregnancy puts on the heart are an increase in the volume of blood in the body (which requires the heart to pump more), an increase in heart rate by about 10 to 15 beats per minute, and potentially dangerous changes in blood pressure.
While women with pre-existing heart conditions are urged to take some precautions during pregnancy, not all women know they have a heart condition and some heart issues begin only as a result of a pregnancy. Heart conditions that develop silently and suddenly during pregnancy are more common than pre-existing heart disease, according to ACOG. These can include high blood pressure, a heart attack (very rare) or an abnormal heart rhythm, which can be an indication of a heart problem. ACOG recommends that all women be assessed for risk of heart disease during the prenatal and postpartum periods.
Raising awareness and improving care
According to the CDC, everyone involved in pregnancy, delivery and care for mothers after a baby is born has a role to play in preventing pregnancy-related deaths. For mothers, that role is to learn about warning signs of complications and to tell healthcare practitioners about current or recent pregnancies whenever they get medical care, especially within the first year after having a baby.
“Our new analysis underscores the need for access to quality services, risk awareness, and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths,” said Wanda Barfield, M.D., M.P.H., F.A.A.P., director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention and Health Promotion. “By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives.”
To reduce the risk of pregnancy-related deaths, it’s critical to make and keep all recommended prenatal appointments and to have all recommended tests – such as blood pressure checks – on time, as well as follow up on test results and any treatment recommendations.
Lab Tests Online offers a detailed guide to the tests recommended for women before and during pregnancy.
May 7, 2019. Centers for Disease Control and Prevention. Press Release: Pregnancy-Related Deaths Happen Before, During, and Up to a Year After Delivery. Available online at https://www.cdc.gov/media/releases/2019/p0507-pregnancy-related-deaths.html. Accessed on May 20, 2019.
May 7. Centers for Disease Control and Prevention. Vital Signs: Pregnancy-related deaths. Saving women’s lives before, during and after delivery. Available online at https://www.cdc.gov/vitalsigns/maternal-deaths/index.html. Accessed May 20, 2019.
May 3, 2019. American College of Obstetricians and Gynecologists. Press Release: ACOG Releases Comprehensive Guidance on How to Treat the Leading Cause of U.S. Maternal Deaths: Heart Disease in Pregnancy. Available online at https://www.acog.org/About-ACOG/News-Room/News-Releases/2019/ACOG-Releases-Comprehensive-Guidance-on-How-to-Treat-Heart-Disease-in-Pregnancy?IsMobileSet=false. Accessed May 20, 2019.
May 3, 2019. Obstetrics and Gynecology, Practice Bulletin 212. Pregnancy and Heart Disease. Available online at https://journals.lww.com/greenjournal/Abstract/2019/05000/ACOG_Practice_Bulletin_No__212__Pregnancy_and.40.aspx. Accessed May 20, 2019.
Last Review May 1, 2019. Heart Disease and Pregnancy. Cleveland Clinic. Available online at https://my.clevelandclinic.org/health/diseases/17068-heart-disease–pregnancy. Accessed May 20, 2019.
Petersen E, et. al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017, Weekly / May 10, 2019 / 68(18);423–429. Available online at https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm. Accessed May 22, 2019.
American College of Obstetricians and Gynecologists. Maternal Mortality. Available online at https://www.acog.org/About-ACOG/ACOG-Departments/Government-Relations-and-Outreach/Federal-Legislative-Activities/Maternal-Mortality?IsMobileSet=false. Accessed May 30, 2019.