Abstract P318: Wide State-By-State Variation in Maternal Mortality and Chronic Diseases That Contribute to Pregnancy Complications

Abstract

Background: Among developed countries, the United States has the highest maternal mortality rate. Between 1987 and 2011, the US maternal mortality rate more than doubled from 7.2 to 17.8 deaths per 100,000 live births. More than 1,300 pregnancy-related deaths occurred in the United States in 2011-2012. Additionally, an increasing number of women have chronic health conditions, such as hypertension, diabetes, and chronic heart disease, that increase their risk of pregnancy complications, including maternal mortality. Reducing the prevalence of these diseases may be an important step toward reducing maternal mortality. To examine the current state of maternal mortality and chronic diseases in the United States, the geographical variation of these factors was examined. Methodology: State-level prevalence estimates were calculated for diabetes, heart disease, and hypertension awareness among women of reproductive age (18 to 44 years) using data from the 2013-2014 Behavioral Risk Factor Surveillance System. State-level maternal mortality rates were calculated using CDC’s 2010-2014 National Vital Statistics System. Maternal mortality was defined as the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births. Results: The maternal mortality rate is 6.8 times higher in Georgia (39.3 deaths per 100,000 live births) than in Massachusetts (5.8 deaths per 100,000 live births). Nationally, there are an estimated 19.9 maternal deaths per 100,000 live births. The prevalence of chronic diseases that increase risk of pregnancy complications also vary by state. For example, diabetes (excluding gestational diabetes) ranges from a low of 1.9% of women aged 18 to 44 in Alaska, Minnesota, and Wisconsin to a high of 4.8% in Alabama. Nationally, an estimated 3.1% of women aged 18 to 44 have been told by a doctor that they have diabetes. Conclusion: The prevalence of chronic diseases in women of reproductive age vary based on state of residence, as does the maternal mortality rate. Raising awareness about the variation in these measures is an important step toward identifying what strategies are being utilized in states with a low prevalence of diabetes, heart disease, and hypertension, and determining how their public health efforts may help those states facing challenges in these areas.