Pre-ex­ist­ing con­di­tions con­trib­ute to ris­ing U.S. ma­ter­nal mor­tal­ity rates

Modern Healthcare - - NEWS - By Maria Castel­lucci

Ma­ter­nal mor­tal­ity rates in the U.S. are on the rise, and many women are dy­ing from pre-ex­ist­ing health con­di­tions, ac­cord­ing to a re­port by Ge­orge­town Univer­sity School of Nurs­ing and Health Stud­ies.

The lead­ing cause of ma­ter­nal mor­tal­ity in the U.S. is car­dio­vas­cu­lar dis­ease, which ac­counts for 15% of deaths. Trail­ing closely are non­car­dio­vas­cu­lar diseases such as diabetes, which cause 14% of deaths dur­ing preg­nancy or child­birth, and in­fec­tion or sep­sis, which ac­count for the same per­cent­age of deaths. Ge­orge­town’s data come from the Cen­ters for Dis­ease Con­trol and Preven­tion.

Ma­ter­nal mor­tal­ity has been on the rise in the U.S. since the CDC be­gan track­ing it in 1987. The rate has in­creased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009 and 2011.

Para­dox­i­cally, ex­perts say the rise in ma­ter­nal mor­tal­ity, par­tic­u­larly car­dio­vas­cu­lar dis­ease-re­lated deaths, can be at­trib­uted to ad­vances in car­diac care in the U.S.

“Women who had a con­gen­i­tal heart de­fect or a car­diac con­di­tion when they were younger are now liv­ing longer, and hav­ing surgery, and they’re con­se­quently get­ting preg­nant,” said Dr. Whit­ney You, a ma­ter­nal fe­tal medicine spe­cial­ist at North­west­ern Univer­sity.

Ni­cola Haw­ley, an as­so­ciate pro­fes­sor of epi­demi­ol­ogy at Yale School of Pub­lic Health who fo­cuses on ma­ter­nal health, agreed, but she said obe­sity also plays a role. Haw­ley said doc­tors should mon­i­tor obe­sity to avoid diabetes, high blood pres­sure and other con­di­tions that can be harm­ful to moth­ers and ba­bies. Sep­sis-re­lated deaths are also more likely to oc­cur among women with diabetes or obe­sity, You said.

Ce­sarean sec­tions can lead to hem­or­rhag­ing, which ac­counted for 11.3% of deaths in the U.S. in 2011.

In 2013, 32.7% of U.S. births were C-sec­tions, which is above the 10% to 15% rec­om­mended by the World Health Or­ga­ni­za­tion (WHO).

While mor­tal­ity rates in the U.S. are ris­ing, rates in other re­gions are de­clin­ing. In Europe, the ma­ter­nal mor­tal­ity rate has de­creased by 64% since 1990. In Africa, that rate has dropped by 44%. In 2015, ma­ter­nal mor­tal­ity in Europe was 16 deaths per 100,000 live births in 2015, while Africa’s rate was 542 deaths per 100,000 live births, ac­cord­ing to the WHO.

The de­clines in th­ese re­gions can be linked to the United Na­tions Mil­len­nium De­vel­op­ment Goal in 1990 to de­crease the ma­ter­nal mor­tal­ity rate by 75% world­wide by 2015. The UN re­ported the goal will not be met. Still, ma­ter­nal mor­tal­ity has de­creased by 45% since 1990.

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