Abstract 18851: Cardiovascular Disease: The Leading Cause of Pregnancy-Related Death in California 2002-2005

Abstract

Introduction: The California Pregnancy-Associated Mortality Review (CA-PAMR) was started in 2006 by the California Department of Health, Maternal, Child, and Adolescent Health Division in response to rising rates of maternal mortality with the goal of understanding and reducing maternal morbidity and mortality. Methodology: CA-PAMR uses an enhanced surveillance methodology to identify and investigate maternal deaths, as described previously. An expert committee reviewed medical records to determine pregnancy-related deaths, their clinical causes, contributing factors and opportunities for quality improvement. Results: From 2002-2005, there were 2,147,492 live births and 732 women died while pregnant or within 1 year of pregnancy. Among them, 207 were determined to be pregnancy-related: 53 were from cardiovascular disease (CVD) and two-thirds (n=33) of those from cardiomyopathy (CMP). Compared to women who died from non-cardiac causes, women who died from any CVD were twice as likely to be African-American (39% vs. 17%, p<.01) and obese (BMI>30) (42% vs. 26%, p<.05), and had documented substance abuse during pregnancy (27% vs. 10%, p<.01) and to die ≥ 42 days postpartum (31% vs. 6%, p<.01). Almost a quarter (22%) of CVD deaths had a concomitant diagnosis of hypertension or preeclampsia. Similarly, the CMP deaths were three times as likely to be African-American (46% vs. 18%, p<.01), twice as likely to be obese (47% vs 27%, p<.05), four times as likely with substance abuse (37% vs. 9%, p<.01), and to die ≥ 42 days postpartum (46% vs. 5%, p<.01). Concomitant diagnosis of hypertension or preeclampsia occurred in 30% of CMP deaths. Overall, for those diagnosed before death (n=29), the mean time from symptom onset to diagnosis was 26 days (range=0, 223 days) and from diagnosis to death was 79 days (range 0, 347 days). Patient and health care provider factors were identified as having contributed to 86% and 71% of the deaths respectively, and 30% of the CVD deaths were considered potentially preventable. Conclusion: Medical expert review of maternal deaths has provided additional insight into CVD deaths that occur during or after pregnancy. Earlier recognition and referral of a symptomatic patient by obstetric providers may help prevent serious morbidity and mortality.