Abstract
We conducted an epidemiologic study in order to identify trends in overall maternal mortality in the United States from 1979-2017. We performed a retrospective cohort study of all maternal live births and deaths in the United States from 1979 to 2017 as reported by the Center for Disease Control and Prevention. Maternal mortality was defined as any death occurring in pregnancy or within 42 days of the end of pregnancy. Maternal mortality rates (MMR) were determined by race and broad disease category of maternal death, as coded by ICD-9 or ICD-10. Changes maternal mortality ratios were estimated from Poisson models before and after adjusting for maternal age and race. During the study period, there were 152,263,415 live births in the United States. There were 24,372 maternal deaths, 61.3% in whites and 33.4% in blacks. As shown in Figure 1, the overall MMR increased from 12.25 in 1979 to 33.78 in 2017 (adjusted RR 2016-2017 vs. 1979-1980 2.10, 95% CI 1.93-2.29). The most noticeable increase in yearly MMR occurred after 2003 when a standard pregnancy checkbox was added to the death certificate. When evaluated by race, there were significantly lower MMRs in whites as compared to blacks. In whites the rate rose from 8.2 in 1979 to 29.82 in 2017 while in blacks it rose from 32.55 in 1979 to 58.4 by 2017. When stratified by broad disease category (Table 1), most significantly there was a 35% increase in the rate of death due to ‘Other maternal disorders predominantly related to pregnancy’, which includes hemorrhage, VTE, liver disorders, and anesthesia complications (adjusted RR 2016-2017 versus 1979-1989 40.95, 95% CI 21.88-76.64). The overall maternal mortality rate in the United States rose significantly from 1979-2017. Mortality rates in non-Hispanic black patients is the highest and this remains consistent across all disease categories, but racial disparity gap appears to be closing.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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