Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017

Abstract

Background: Approximately 700 women die from pregnancy-related complications in the United States every year.Methods: Data from CDC's national Pregnancy Mortality Surveillance System (PMSS) for 2011-2015 were analyzed.Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics.The distribution of pregnancy-related deaths by timing relative to the end of pregnancy and leading causes of death were calculated.Detailed data on pregnancy-related deaths during 2013-2017 from 13 state maternal mortality review committees (MMRCs) were analyzed for preventability, factors that contributed to pregnancy-related deaths, and MMRC-identified prevention strategies to address contributing factors.Results: For 2011-2015, the national PRMR was 17.2 per 100,000 live births.Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white (white) women (13.0).Timing of death was known for 87.7% (2,990) of pregnancy-related deaths.Among these deaths, 31.3%occurred during pregnancy, 16.9% on the day of delivery, 18.6% 1-6 days postpartum, 21.4% 7-42 days postpartum, and 11.7% 43-365 days postpartum.Leading causes of death included cardiovascular conditions, infection, and hemorrhage, and varied by timing.Approximately sixty percent of pregnancy-related deaths from state MMRCs were determined to be preventable and did not differ significantly by race/ethnicity or timing of death.MMRC data indicated that multiple factors contributed to pregnancy-related deaths.Contributing factors and prevention strategies can be categorized at the community, health facility, patient, provider, and system levels and include improving access to, and coordination and delivery of, quality care.Conclusions: Pregnancy-related deaths occurred during pregnancy, around the time of delivery, and up to 1 year postpartum; leading causes varied by timing of death.Approximately three in five pregnancy-related deaths were preventable.Implications for Public Health Practice: Strategies to address contributing factors to pregnancy-related deaths can be enacted at the community, health facility, patient, provider, and system levels.MMWR / May 10, 2019 / Vol.68 / No. 18 US Department of Health and Human Services/Centers for Disease Control and Prevention SummaryWhat is already known about this topic?Approximately 700 women die annually in the United States from pregnancy-related complications.What is added by this report?Among pregnancy-related deaths for which timing was known, 31.3%deaths occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days 1-6 postpartum, 21.4% on days 7-42 postpartum, and 11.7% on days 43-365 postpartum.Leading causes of death varied by timing relative to the end of pregnancy.Approximately three in five pregnancy-related deaths were preventable.Contributing factors can be categorized at the community, health facility, patient, provider, and system levels.What are the implications for public health practice?Most pregnancy-related deaths are preventable, demonstrating the need to identify and implement strategies to address the multiple contributing factors.