Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

Abstract

The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

Figure 1.

Leading causes of pregnancy-related death, by timing of death. Adapted from Petersen EE, Davis NL, Goodman D,etal. Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019;68:423–429. Note: Cardiac conditions include both cardiomyopathy and other cardiovascular disease.

Figure 2.

Proportion of pregnancy-associated deaths determined to be pregnancy-related based on race and ethnicity. Adapted from Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from 9 maternal mortality review committees. http://reviewtoaction.org/Report_from_Nine_MMRCs. (22)

Figure 3.

Preventability of pregnancy-related deaths by time of death in analysis of 9 state maternalmortality review committees. Adapted from Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from 9 maternalmortality review committees. http://reviewtoaction.org/Report_from_Nine_MMRCs. (22)