Today CDC will release a Vital Signs report showing that nearly a third (31%) of pregnancy-related deaths happen during pregnancy, just over a third (36%) happen during delivery or the week after, and exactly a third (33%) happen one week to one year after delivery.
However, 3 in 5 pregnancy-related deaths could be prevented, no matter when they occur.
The findings come from a CDC analysis of 2011–2015 national data on pregnancy mortality and of 2013–2017 detailed data from 13 state maternal-mortality review committees. Pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy.
The data confirm persistent racial disparities: Black and American Indian/Alaska Native women were about three times as likely as white women to die from a pregnancy-related cause. But the new analysis found that most deaths were preventable, regardless of race/ethnicity.
The analysis also found that leading causes of death differed throughout pregnancy and after delivery.
- Heart disease and stroke caused more than 1 in 3 deaths overall.
- Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), caused most deaths at delivery.
- In the week after delivery, severe bleeding, high blood pressure, and infection were most common.
- Cardiomyopathy (weakened heart muscle) caused most deaths 1 week to 1 year after delivery.
The report also summarizes potential prevention strategies from 13 state maternal mortality review committees (MMRCs). MMRCs are multidisciplinary groups of experts that review maternal deaths to better understand how to prevent future deaths.
The committees determined that pregnancy-related deaths are associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. MMRC data suggest that the majority of deaths—regardless of when they occurred—may have been prevented by addressing these factors at multiple levels to prevent deaths during pregnancy, at labor and delivery and in the postpartum period:
- Providers and patients can work together to manage chronic conditions and have ongoing conversations about the warning signs of complications.
- Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among healthcare providers. They can also work to improve delivery of quality care before, during, and after pregnancy and standardize approaches for responding to obstetric emergencies.
- States and communities can address social determinants of health, including providing access to housing and transportation. They can develop policies to ensure high-risk women are delivered at hospitals with specialized healthcare providers and equipment—a concept called “risk-appropriate care.” And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.
- Women and their families can know and communicate about the warning symptoms of complications and note pregnancy history any time medical care is received in the year after delivery.
CDC is prioritizing the lives of America’s mothers to prevent pregnancy-related death. CDC tracks pregnancy-related mortality and severe pregnancy complications. The agency provides technical assistance and resources to MMRCs to review maternal deaths and make prevention recommendations.
CDC will provide support to as many as 25 MMRCs across the country through the Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees funding opportunity, beginning in Fall 2019. CDC also funds 13 state perinatal quality collaboratives and the National Network of Perinatal Quality Collaboratives to improve the quality of care for mothers and their babies. To help states standardize their assessment of levels of maternal and newborn care for their delivery hospitals, CDC offers the CDC Levels of Care Assessment Tool and provides technical assistance to those who want to use it. And CDC is working to educate the public about pregnancy-related death.
Please share this information broadly with your colleagues and partners; the information will be available at: www.cdc.gov/vitalsigns. I look forward to continuing to work with you all to increase awareness about the signs of serious pregnancy complications, and the need for preventative care that can and does save lives.
Dr. Wanda Barfield
Director of Division of Reproductive Health