- •
Maternal mortality plagues much of the world, with 303,000 maternal deaths in 2015. This number represents a global maternal mortality ratio of 216 maternal deaths per 100,000 live births.
- •
The World Health Organization has created a goal to decrease the global maternal mortality ratio to 70 maternal deaths per 100,000 live births by the year 2030.
- •
The maternal mortality ratio is higher in the United States than in any other developed nation and has increased over the last several years.
- •
Maternal Mortality in the Twenty-First Century
Section snippets
Key points
Maternal mortality in the United States
To understand current maternal mortalities and trends in the United States, it is important to recognize the terminology that is used. There are several terms, each with a slightly different definition and resultant different rates of maternal mortality. The use of multiple terms often leads to differing reports of maternal mortality in both popular and scientific literature. Current frequently used terminology and definitions include the following:
- •
Pregnancy-Related Death (Centers for Disease
Racial disparities and maternal mortality in the United States
In an analysis of pregnancy-related death in the United States from 2006 to 2010, significant racial disparities in pregnancy-related mortality ratios were demonstrated.15 It was found that a significantly higher proportion of non-Hispanic black women experienced pregnancy-related death compared with non-Hispanic white women. Although women in all racial groups were found to be at increased risk of pregnancy-related death with increasing age, this finding was particularly pronounced among
Preventability
Multiple studies have demonstrated that almost half of pregnancy-related deaths in the United States are preventable.22, 23 In a retrospective study of maternal deaths in North Carolina, 108 pregnancy-related deaths were reviewed by the North Carolina Pregnancy-Related Mortality Review Committee.22 They found that 40% of pregnancy-related deaths were potentially preventable and that preventability varied by cause. They reported that 93% of hemorrhage-related deaths, 60% of hypertension-related
Severe maternal morbidity
Like maternal mortality, severe maternal morbidity is increasing in the United States.11, 27, 28 It is currently estimated to affect at least 50,000 women per year with an occurrence of 0.5% to 1.3% of pregnancies in the United States.27, 28 Because severe maternal morbidity lies within a continuum ranging from healthy pregnancy to death, efforts to identify and prevent causes of severe maternal morbidity are thought to ultimately decrease morbidity and, hence, maternal mortality.22, 24, 25, 26
Strategies for reduction of maternal mortality
The CDC established the pregnancy mortality surveillance system in 1986, which collects data from 52 reporting areas (50 states, New York City, and Washington, DC).9 The CDC requests that these areas voluntarily submit copies of death certificates for all women who died during pregnancy or within 1 year of pregnancy along with copies of the matching birth or fetal death certificates.9 This information yields valuable epidemiologic data regarding causes and risk factors associated with maternal
Summary
Despite improvements in rates of global maternal mortality over the last century, it remains a problem that continues to plague much of the world. Rates of maternal mortality are increasing in the United States with significant racial disparities that disproportionately affect non-Hispanic black women. Up to half of pregnancy-related deaths in the United States have been found to be preventable.14, 21, 22 There are strategies that have been shown to reduce the rates of severe maternal morbidity
References (42)
- et al.
Abortion surveillance at CDC: creating public health light out of political heat
Am J Prev Med
(2000) - et al.
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Lancet
(2016) - et al.
Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5
Lancet
(2010) - et al.
Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
(2014) - et al.
Pregnancy-related mortality in the United States, 1991-1997
Obstet Gynecol
(2003) - et al.
Pregnant trauma victims experience nearly 2-fold higher mortality compared to their nonpregnant counterparts
Am J Obstet Gynecol
(2017) - et al.
The continuum of maternal morbidity and mortality: factors associated with severity
Am J Obstet Gynecol
(2004) - et al.
A scoring system identified near-miss maternal morbidity during pregnancy
J Clin Epidemiol
(2004) - et al.
Putting the “M” back in maternal-fetal medicine
Am J Obstet Gynecol
(2013) - et al.
Measuring severe maternal morbidity: validation of potential measures
Am J Obstet Gynecol
(2016)
Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety
Am J Obstet Gynecol
Death in childbirth: an international study of maternal care and maternal mortality, 1800–1950
Healthier mothers and babies
MMWR Morb Mortal Wkly Rep
Strategies toward ending preventable maternal mortality (EPMM)
Changes in pregnancy mortality ascertainment: United States, 1999-2005
Obstet Gynecol
Health care disparity and state-specific pregnancy-related mortality in the United States, 2005-2014
Obstet Gynecol
Pregnancy-related mortality in the United States, 2006-2010
Obstet Gynecol
Cited by (0)
The authors have no financial disclosures.