To a physician, any disease-related death is one too many. But death is a certainty of life; and despite best efforts, deaths from cancer, heart disease and/or Alzheimer’s are more readily understood, albeit painfully accepted.
Not so with death near the time of birth.
To hear that a woman has died during her pregnancy, or shortly after giving birth, is seemingly more stunning to the senses. But all physicians and the general public need to take note of a statistic that, for years, has gone unnoticed by many: There has been a persistent increase in maternal mortality from pregnancy-related causes.
A “pregnancy-related death” is defined as “death of a woman while pregnant or within 1 year of pregnancy termination—regardless of the duration or site of the pregnancy—from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.”
Since 1990, the rate of pregnancy-related deaths for all women in the United States has essentially doubled, according to the Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System. Between 1987-1990, the rate was 9.1 pregnancy-related deaths per 100,000 live births; the rate in 2011 was 17.8/100,000 (Figure 1). (2)
CDC researcher Dr. Andreea Creanga and colleagues published this data in the American College of Obstetricians and Gynecologists’ January 2015 issue of Obstetrics & Gynecology.
The data indicate that pregnancy-related mortality increased for all American women and within all age groups. The greatest threat is in women 40 years of age and older, regardless of race (Figure 2). (1) The increase of deaths in women of advanced maternal age is not surprising. American women are increasingly delaying childbirth until their later years, and many undergo assisted-reproductive procedures such as IVF. With that, there is a greater potential for many pregnant women to already carry chronic conditions such as hypertension, heart disease and diabetes. Add in race, social determinants and other demographic factors, and it’s easy to see that the kettle is a’brewing.
Additionally, Hispanics with less than 12 years of education, and Blacks who get pregnant outside of wedlock have higher rates of mortality.
…all physicians and the general public need to take note of a statistic that, for years, has gone unnoticed by many.
Black women have the highest risk of dying from pregnancy complications. Between 2006 and 2010, per 100,000 live births, the mean pregnancy-related mortality ratio in Hispanics was 11.7; Whites, 12.0; and 38.9 for Blacks (Figure 3). (1)
As a Black female ob-gyn who has treated thousands of patients of all races, I assuredly say it is time to change the history of Black women (and men’s) health. Black health matters must matter to Blacks.
Black women have the least successful healthcare outcomes for most killer diseases such as diabetes, hypertension, obesity, and heart disease. Some attribute this to lack of access to care, or no insurance. Those factors may play a role. For those who lack insurance, utilizing community health services, as well as better allocation of discretionary spending is advised. But even for Black women with access and insurance, less successful healthcare outcomes persist.
Black women also experience unique psychosocial stressors—such as colorism, negative media imagery, lack of marriage-minded men—that, due to cortisol stimulation, affect their physical condition, decreases immunity and increases the risk of serious diagnoses.
The increase in pregnancy-related deaths for all American women is important data for obstetricians. But regardless of specialty, all physicians need to advise women patients—White, Black, Hispanic, Asian or other—that there must be a commitment to seek preventative health care, and begin prenatal care early in order to have not only healthy newborns, but healthy mothers alive to care for them.
Melody T. McCloud, MD, is an obstetrician-gynecologist and founder/medical director of Atlanta Women’s Health Care. She is an author, speaker and media consultant. Twitter: @DrMelodyMcCloud. Doximity: “Melody T. McCloud, M.D.”
Readings & Resources (click to view)
1. Creanga, AA. Berg, CJ et al. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol 2015;125:5-13. http://journals.lww.com/greenjournal/toc/2015/01000
2. Centers for Disease Control and Prevention: Pregnancy Mortality Surveillance System. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html