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More Deaths From Pregnancy Complications In The US

December 3, 2010

Though pregnancy-related deaths in the United States remains relatively rare, the national rate of women dying due to pregnancy complications is growing, a government study has recently found.

Researchers from the US Centers for Disease Control and Prevention (CDC) found that between 1998 and 2005, pregnancy-related death rates were 14.5 per 100,000 live births. And even though that number is quite low, it is higher than at any time in the past few decades, according to a Reuters report.

The extent to which the rise reflects a true elevation in pregnancy-related risk of dying is unclear, the researchers cautioned. Recent changes in how causes of death are officially reported by states to the feds may be at least partially responsible for the findings.

It is possible that part of the increase is “real.” According to new data, deaths from chronic medical conditions that are often made worse by pregnancy, including heart disease, appear to account for a growing number of pregnancy-related deaths. But on the other hand, deaths from actual obstetric complications, such as hemorrhaging and pregnancy-related high blood pressure, are surprisingly declining.

The overall risk of American women dying from pregnancy-related issues is still “very small,” lead researcher Dr. Cynthia J. Berg, of the CDC’s division of reproductive health, told Reuters Health in an interview.

She said, however, that the new findings do emphasize the importance of women “making sure they are in the best possible health before pregnancy.”

All women should try to have a pre-pregnancy visit with their ob-gyn and, if needed, get their weight and any chronic medical conditions under control before becoming pregnant, Berg said.

Berg and her colleagues sifted through data on 4,693 pregnancy-related deaths reported to the CDC between 1998 and 2005. Pregnancy-related death was any death that occurred during or within one year or pregnancy and was accredited to a pregnancy complication.

The team estimated that the national rate of pregnancy-deaths was 14.5 per 100,000 live births for the eight-year study period. That is nearly double the numbers from 1986, when the pregnancy-related death rate fell to as low as 7.4 per 100,000 live births that year. Since then, there was a gradual increase in pregnancy-related deaths.

Berg said the reasons for the growing trend in overall pregnancy-related deaths are not certain, and more studies are needed to determine what contributing factors are involved.

The research team said one factor could be two technical changes in how cases of death are officially reported. The United States adopted an updated system for coding causes of death, which allowed for more deaths to be classified as “maternal.”

In 2003, the system was updated to include a “pregnancy checkbox,” which increased the number of deaths that could be linked, time wise, to pregnancy.

In recent years, not only has changes in the rate of pregnancy-related deaths occurred, but also in the specific causes.

Berg told Reuters Health that the proportion of deaths from obstetrical complications is going down, while the proportion attributed to indirect causes — medical conditions that worsened due to pregnancy — is increasing.

Hemorrhaging, one direct complication of pregnancy, accounted for nearly 30 percent of pregnancy-related deaths between 1987 and 1990, but only 12 percent between 1998 and 2005. High blood pressure disorders, mainly preeclampsia, also accounted for 12 percent of deaths between 1998 and 2005, down from 18 percent between 1987 and 1990.

In contrast, there was a sharp increase in the proportion of deaths accredited to heart problems. Between 1998 and 2005 about 12 percent of pregnancy-related deaths were attributed to cardiovascular complications, and another near-12 percent were attributed to enlargement of the heart.

Whereas only about 5 percent of deaths were associated to enlargement of the heart between 1987 and 1990, and even a smaller percentage for cardiovascular conditions.

While the study cannot separate the precise reasons for these patterns, Berg noted that “our population is changing.”

More women of childbearing age today are obese or have chronic health problems like high blood pressure and diabetes than women of years past. That could explain the shifting pattern in the causes of pregnancy-related deaths, Berg said.

Even though the numbers are still quite low for pregnancy-related deaths, Berg said it is important to go into pregnancy in the best possible health.

The CDC report was published in the recent issue of Obstetrics & Gynecology

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