Are Pregnant Women in the U.S. in Danger?

The death rate for American women during or soon after pregnancy has increased dramatically – and researchers want to know why.

In earlier times, childbirth was often a dangerous and life-threatening event for many women. Fortunately, modern advances in prenatal and childbirth care eventually made having babies far less risky for moms and their infants. 

The World Health Organization (WHO) reports the rate of maternal mortality (the death of a woman while pregnant, or within 42 days after a pregnancy ends, from any cause related to or aggravated by pregnancy) dropped by about 44 percent worldwide between 1990 and 2015. But despite this good news, every day across the globe about 830 women still die from preventable causes related to pregnancy and childbirth, according to the WHO. 

If you think this is a problem restricted to poor third world nations, think again. While 157 of 183 countries have shown steady decreases in maternal mortality between 1990 and 2015, the U.S. is not one of them.

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In fact, between 2000 and 2014, the maternal mortality rate for American women soared almost 27 percent. Among 31 industrialized nations, only Mexico has a worse rate of pregnancy associated deaths than the U.S. 

These troubling findings were uncovered in a study published in the journal Obstetrics & Gynecology by researchers from the University of Maryland Population Research Center (MPRC), Boston University School of Public Health (BUSPH), and Stanford University’s California Maternal Quality Care Collaborative. The research team worked with data on pregnancy-linked deaths available from the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC).

“It’s important to note that maternal death is still a rare event, but it is of great concern that the rate is increasing, rather than improving,” said Marian MacDorman, PhD, a MPRC research professor who headed the study. “Maternal mortality is an important indicator of the overall quality of healthcare both nationally and internationally.”

Accurate information about causes of maternal mortality are important for prevention efforts to identify women who are particularly at-risk can be and measure the results of any intervention programs to reduce pregnancy-related deaths. However, the researchers noted they’ve had had difficulty getting all the facts they need. They’ve been hampered due to discrepancies in how maternal mortality has been reported in the U.S. over the past decade. In addition, some states have fallen behind in noting pregnancy status on death certificates.

Based on available information, the researchers suggested the U.S. obesity epidemic may be one important factor in the rising maternal mortality rate in this country. A report from the CDC National Center on Health Statistics on pre-pregnancy weights available for 2014 revealed about one half of American women were overweight or obese before they became pregnant.

Obesity during pregnancy raises the risk of several serious health problems, including gestational diabetes, preeclampsia (a high blood pressure disorder that can cause kidney and liver failure), and sleep apnea, according to the American College of Obstetricians and Gynecologists. 

"The current maternal mortality rate places the United States far behind other industrialized nations," said study co-author Eugene Declercq, PhD, professor of community health sciences at BUSPH. "There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the four million U.S. women giving birth each year."

The findings from Declercq and colleagues revealed a possible way this goal can be accomplished, based on the success of a California initiative to reduce maternal mortality. 

California instituted a state-wide program to review pregnancy-associated deaths and then launched efforts to prevent some of the most common contributors to maternal death they identified – including obstetric hemorrhage and preeclampsia. The result was a significant decline in deaths associated with pregnancy from 2003 to 2014. 

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