Abstract
INTRODUCTION: Over the past two decades, there has been a trend toward increasing maternal age in the United States. The study objective was to examine the association of maternal age with maternal mortality in the United States and examine temporal trends in mortality by maternal age. METHODS: A nationwide population-based cross-sectional study in the United States between 2000 and 2019 was conducted using data from the Centers for Disease Control and Prevention’s “Birth Data” and “Mortality Multiple Cause” data files. Annual incidence and period trends in maternal deaths were calculated using the annual maternal deaths over annual live births across age groups. Multivariate logistic regression models were used to estimate the association between maternal age and risk of maternal mortality and calculate temporal changes in risk of mortality over the study period. RESULTS: Between 2000 and 2019, 21,241 deaths were observed in women during pregnancy and childbirth for an average incidence of 26.3 maternal deaths/100,000 births (95% CI 21.8–31.2). Of all deaths, 6,870 (32.3%) were in women 35 years or older, while only 15.1% of live births were attributed to women 35 years or older. Compared with women 25–29 years of age, there was a significantly greater risk of maternal mortality among women 35–39 (odds ratio 1.60, 95% CI 1.53–1.67), 40–44 (3.78, 3.60–3.99), 45–49 (28.49, 26.49–30.65), and 50–54 (343.50, 319.44–369.37). Risk of mortality increased over time, with the greatest rise in women 35 years or older. CONCLUSION: In the United States, maternal mortality increased during the past two decades, especially in women 35 years or older. Given these findings, targeted strategies to reduce the increasing maternal mortality should become a priority.
Published Version
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