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

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.