Perspective

More than 60% of US maternal deaths are preventable

In the United States, 63% of all pregnancy-related deaths could have been prevented, according to findings from the Report from Nine Maternal Mortality Review Committees, an initiative affiliated with the CDC Foundation.

The Building U.S. Capacity to Review and Prevent Maternal Deaths project team developed the report to offer an evidence-based analysis of the causes, contributors and recommendations for prevention of maternal mortality using data from nine states.

Although pregnancy-related deaths in the United States are rare, with about 700 women dying of complications each year, the report suggests that many of these deaths are preventable. A total of 63.2% of overall deaths related to pregnancy, 68.2% of cardiovascular and coronary deaths and 70% of deaths due to hemorrhage could have been prevented, according to the report.

The team also found that maternal death was caused by direct and underlying causes. Direct causes, including hemorrhage, cardiovascular and coronary conditions, cardiomyopathy or infection contributed to almost half of pregnancy-related deaths. Underlying causes of maternal death varied by race. Preeclampsia, eclampsia and embolism contributed to most maternal deaths among non-Hispanic black women, while mental health conditions were substantial causes of death among non-Hispanic white women.

For each pregnancy-related death, there was an average of four contributing factors, according to the report. The most common contributing factors of maternal death were patient and family factors, including lack of knowledge on warning signs and when to seek care. Other common contributing factors included provider factors, such as misdiagnosis and ineffective treatments, and system of care factors, such as poor coordination between providers.

The authors noted that although patient factors contributed most to maternal death, those factors often depend on providers and systems of care.

Pregnancy-related deaths are three to four times more likely to occur among non-Hispanic black women than non-Hispanic white women; therefore, the authors underscore the effect social determinants of health have on maternal death and provide an equity framework to tackle such disparities.

The team provided several recommendations to address and prevent pregnancy-related deaths:

  • improve physician training;
  • improve communication between patients and providers;
  • improve and enforce policies and procedures regarding prevention initiatives, patient management and communication and coordination between providers;
  • improve assessment, diagnosis and treatment decision standards;
  • allow greater access to care; and
  • establish levels of appropriate maternal care.

“To turn the tide on maternal mortality in the U.S. we must build on current momentum and support the critical work of [maternal mortality review committees],” the authors wrote.

“These recommendations for action will be beneficial for public health and clinical care decision-makers as they design strategies to eliminate preventable maternal deaths at the local, state, regional and national levels,” they added. “Describing recommendations for each of the leading causes of death is an important step forward; determining the potential of a recommendation to prevent maternal deaths remains an important opportunity for the future.” – by Alaina Tedesco

In the United States, 63% of all pregnancy-related deaths could have been prevented, according to findings from the Report from Nine Maternal Mortality Review Committees, an initiative affiliated with the CDC Foundation.

The Building U.S. Capacity to Review and Prevent Maternal Deaths project team developed the report to offer an evidence-based analysis of the causes, contributors and recommendations for prevention of maternal mortality using data from nine states.

Although pregnancy-related deaths in the United States are rare, with about 700 women dying of complications each year, the report suggests that many of these deaths are preventable. A total of 63.2% of overall deaths related to pregnancy, 68.2% of cardiovascular and coronary deaths and 70% of deaths due to hemorrhage could have been prevented, according to the report.

The team also found that maternal death was caused by direct and underlying causes. Direct causes, including hemorrhage, cardiovascular and coronary conditions, cardiomyopathy or infection contributed to almost half of pregnancy-related deaths. Underlying causes of maternal death varied by race. Preeclampsia, eclampsia and embolism contributed to most maternal deaths among non-Hispanic black women, while mental health conditions were substantial causes of death among non-Hispanic white women.

For each pregnancy-related death, there was an average of four contributing factors, according to the report. The most common contributing factors of maternal death were patient and family factors, including lack of knowledge on warning signs and when to seek care. Other common contributing factors included provider factors, such as misdiagnosis and ineffective treatments, and system of care factors, such as poor coordination between providers.

The authors noted that although patient factors contributed most to maternal death, those factors often depend on providers and systems of care.

Pregnancy-related deaths are three to four times more likely to occur among non-Hispanic black women than non-Hispanic white women; therefore, the authors underscore the effect social determinants of health have on maternal death and provide an equity framework to tackle such disparities.

The team provided several recommendations to address and prevent pregnancy-related deaths:

  • improve physician training;
  • improve communication between patients and providers;
  • improve and enforce policies and procedures regarding prevention initiatives, patient management and communication and coordination between providers;
  • improve assessment, diagnosis and treatment decision standards;
  • allow greater access to care; and
  • establish levels of appropriate maternal care.

“To turn the tide on maternal mortality in the U.S. we must build on current momentum and support the critical work of [maternal mortality review committees],” the authors wrote.

“These recommendations for action will be beneficial for public health and clinical care decision-makers as they design strategies to eliminate preventable maternal deaths at the local, state, regional and national levels,” they added. “Describing recommendations for each of the leading causes of death is an important step forward; determining the potential of a recommendation to prevent maternal deaths remains an important opportunity for the future.” – by Alaina Tedesco

    Perspective
    Jeanne Mahoney

    Jeanne Mahoney

    The report released by the project team for Building U.S. Capacity to Review and Prevent Maternal Deaths confirms what we have known for some time, that a majority of the pregnancy-related deaths in this country are preventable.

    What has been lacking has been a nationwide effort to put system-level, quality improvement efforts in place to reverse the rising maternal mortality rate. That is why in 2014, the American College of Obstetricians and Gynecologists, along with other provider, public health and advocacy organizations, developed the Alliance for Innovation on Maternal Health (AIM).

    AIM aligns national, state and hospital level efforts to improve maternal health and safety and is poised to reduce preventable deaths and severe maternal morbidity. With funding received from the Health Resource Services Administration, AIM provides evidence-based front-line resources for birth facilities and provider/public health teams to adapt and implement a series of action steps, or bundles, on high risk maternal conditions.

    AIM supports harmonized data-driven, rapid-cycle, continuous quality improvement processes to engage providers and birth facilities. AIM is being implemented in 18 states and impacts more than one-third of current U.S. births. Data from the first five AIM states indicate an 8% to 21% decrease in severe maternal morbidity from baseline.

    As more states join AIM and hospitals adopt the bundles, I believe over time we will see additional improvements and a marked change in the care provided to pregnant women across the country.

    • Jeanne Mahoney, RN, BSN
    • Senior director, Providers’ Partnership American College of Obstetricians and Gynecologists

    Disclosures: Mahoney reports no relevant financial disclosures.