PREGNANCY-RELATED MORTALITY IN THE UNITED-STATES, 1987-1990

Objective: To use data from the Centers for Disease Control and Preven tion's (CDC) Pregnancy-Related Mortality Surveillance System to examin e trends in pregnancy-related mortality and risk factors for pregnancy -related death. Methods: In collaboration with ACOG and state health d epartments, the Pregnancy-Related Mortality Surveillance System has co llected information on all deaths caused by pregnancy since 1979. Mult iple data sources were used, including national death files, state hea lth departments, maternal mortality review committees, individuals, an d the media. As part of the initiation of the Pregnancy-Related Mortal ity Surveillance System in 1987, CDC staff contacted state health depa rtment personnel and encouraged them to identify and report pregnancy- related deaths. Data were reviewed and coded by experienced clinicians . Pregnancy-related mortality ratios (pregnancy-related deaths per 100 ,000 live births) were calculated. Results: After decreasing annually after 1979, the reported pregnancy-related mortality ratio increased f rom 7.2 in 1987 to 10.0 in 1990. This increase occurred among women of all rates. A higher risk of pregnancy-related death was found with in creasing maternal age, increasing live-birth order, no prenatal care, and among unmarried women. The leading causes of pregnancy-related dea th were hemorrhage, embolism, and hypertensive disorders of pregnancy. During the periods 1979-1986 and 1987-1990, the cause-specific pregna ncy-related mortality ratios decreased for deaths due to hemorrhage an d anesthesia, whereas pregnancy-related mortality ratios due to cardio myopathy and infection increased. The leading causes of death varied a ccording to the outcome of the pregnancy. Conclusion: Increased effort s to identify pregnancy-related deaths have contributed to an increase in the reported pregnancy-related mortality ratio. More than half of such deaths, however, are probably still unreported. Adequate surveill ance of pregnancy-related mortality and morbidity is necessary for int erpreting trends, identifying high-risk groups, and developing effecti ve interventions.