Enhanced surveillance for pregnancy-associated mortality - Maryland, 1993-1998

Context Deaths occurring among women who are pregnant or who have had a rec ent pregnancy have a devastating impact on the family and community. It is important to understand the magnitude and causes of pregnancy-associated mo rtality so that comprehensive strategies can be formulated to prevent such deaths. Objective To ascertain the number and causes of pregnancy-associated deaths using enhanced surveillance techniques. Design, Setting, and Subjects Retrospective, cross-sectional analysis of de ath certificate data of reproductive-age women, live birth and fetal death records, and medical examiner records in Maryland during 1993-1998. Main Outcome Measure Number of pregnancy-associated deaths, defined as deat h from any cause during pregnancy or within 1 year of delivery or pregnancy termination, by source of data and cause of death. Results A total of 247 pregnancy-associated deaths were ascertained. Twenty -seven percent (n=67) were identified through cause-of-death information ob tained from death certificates, 70% (n=174) through linkage of death record s with birth and fetal death records, and 47% (n=116) through review of med ical examiner records. Homicide was the leading cause of pregnancy-associat ed death (n=50; 20%), and cardiovascular disorders were the second-leading cause (n=48; 19%). Conclusions In this Maryland sample, comprehensive identification of pregna ncy-associated deaths was accomplished only after collecting information fr om multiple sources and including all deaths occurring up to 1 year after d elivery or pregnancy termination. This enhanced pregnancy mortality surveil lance led to the disturbing finding that a pregnant or recently pregnant wo man is more likely to be a victim of homicide than to die of any other caus e. By broadening pregnancy mortality to include all possible causes, previo usly neglected factors may assume increased importance in prenatal and post partum care.