718: A steady decline across all cardiovascular-disease related maternal mortality in the United States

Abstract

To evaluate trends in cardiovascular disease (CVD)-associated maternal mortality in the United States between 1979 and 2017. We performed a cross-sectional analysis of all live births and maternal deaths in the United States from 1979-2017 using death certificate data from the Centers for Disease Control and Prevention. Maternal mortality was defined as any death during pregnancy and/or within 42 days after a pregnancy (including termination, miscarriage, and birth). CVD-attributable deaths were identified using ICD-9 codes from 1979-1998 and ICD-10 codes from 1999-2017. Maternal mortality ratios (MMR) per 100,000 live births attributable to CVD and CVD subtypes were calculated for each year. CVD-related maternal mortality rate ratios were estimated from Poisson models before and after adjusting for maternal age, race, ethnicity, and resident status, when models allowed. During the study time period, there were 597 cardiovascular disease-related deaths. Although the yearly MMR fluctuated slightly, there was an overall decrease in the MMR from 0.47 per 100,000 live births in 1979 to 0.03 in 2017 (adjusted rate ratio 2016-2017 versus 1979-1980, 0.09, 95% CI 0.04-0.20). As shown in TABLE 1, the highest number of deaths were due to pulmonary heart disease and hypertensive (HTN) heart disease. When focusing on these two subtypes (TABLE 2), during the initial decade, there was an 85% increase in mortality attributable to pulmonary heart disease, but there was a 72% decrease by 2016-2017. The MMR due to HTN heart disease decreased with each decade. CVD- attributable maternal mortality has decreased in the last 39 years in the United States. Pulmonary and HTN- heart disease remain the most significant contributors to this specific cause of deaths, with hypertensive-related deaths declining at a more consistent rate.View Large Image Figure ViewerDownload Hi-res image Download (PPT)