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Deaths during pregnancy or the postpartum period are relatively rare, affecting fewer than 1,000 women in the US most years.
However, maternal mortality is a key indicator of the quality of health care. Most maternal deaths are preventable because measures to avoid or manage life-threatening complications are well known, according to the World Health Organization (WHO).
In addition, the agency says, maternal health and newborn health are closely related.
However, counting maternal deaths is complicated. The US has three different reporting systems, and their results often do not match.
Here is an introduction.
One data source, three reporting systems
All maternal mortality statistics originate from death certificates, which may be completed by an attending or principal physician, nurse, medical examiner, medical examiner, or other person, according to state law. This information goes to three different reporting systems with different strengths and limitations.
The National Center for Health Statistics publishes the official US maternal mortality rate, which is used for international comparisons. It is also known as the National System of Vital Statistics.
- what measure: maternal mortality as defined by the WHO, which is death during pregnancy or within 42 days of the end of pregnancy from any cause related to or aggravated by pregnancy or its management. Deaths are classified using ICD-10 codes.
- Advantages: Data are broken down by state, age group, education level, county urbanization, and race and Hispanic origin. The reports have a relatively short time lag, typically a little over a year.
- Disadvantages: The short time frame of 42 days misses deaths that occur much later in pregnancy. The introduction of a pregnancy checkbox on death certificates has led to better identification of deaths during pregnancy that were not missed in the past, but also to a significant undercount of maternal deaths.
The CDC runs another one Pregnancy mortality surveillance system.
- What are the measurements?: Deaths related to pregnancy, which are deaths during pregnancy or during one year after the end of pregnancy from any cause related to or aggravated by pregnancy. Medical epidemiologists classify deaths.
- Advantages: In addition to death certificates, the system relies on other sources, such as birth and fetal death certificates. Records are reviewed to determine if a death was pregnancy-related. The extended time period includes deaths that occur more than 42 days after pregnancy.
- Disadvantages: Pregnancy-related mortality is not published for individual states. There is a long lag, with the most recent data from 2019.
Maternal Mortality Review Committees exist in most states, as well as New York City, Puerto Rico, Philadelphia and Washington, DC, according to the Guttmacher Institute.
- What they measure: Deaths associated with pregnancy, which are deaths from none cause that occurs within a year of pregnancy. Multidisciplinary committees classify deaths as pregnancy-related or pregnancy-associated (but unrelated).
- Advantages: These experts use a variety of sources, including medical and social service records and interviews to investigate individual deaths, including those linked to social issues such as homicide, suicide and overdose. They gather information on trends in their jurisdiction and recommend improvements in local health and social systems serving women.
- Disadvantages: The reports can be several years old and cannot be compared to national benchmarks, although CDC compilation committees are working on a report of 2017-2019 data from 36 states.
Journalists may also want to examine trends in severe maternal morbidity, which is more common. There are two sources of state data, which are based on hospital discharge data from billing records. Current data is from 2020.
Ask experts, such as public health officials and chairs of state review boards, what drives the numbers and why surveillance methods produce different estimates and trends.
Consider methodological changes that may make identifying trends more difficult. One example is the gradual introduction of a pregnancy checkbox on death certificates between 2003 and 2017, which roughly doubled the observed national maternal mortality rate.
Marie Thoma, Ph.D., a population health scientist at the University of Maryland, said in an interview that reporters can identify general trends in maternal mortality in a given state by using these different data sources as long as the methodology is consistent from year to year. course
What the data shows
These reporting systems reveal themes that can drive story ideas. Here are some of the keys:
- The United States lags behind our peers. Even by the most conservative measures, the US has significantly higher maternal mortality than other major industrialized countries.
- Racial disparities persist. Surveillance shows that blacks and American Indians/Alaska Natives, in particular, have much higher maternal mortality rates. Geographical differences only explain some of the differences.
- Many deaths occur long after birth. Data from the Maternal Mortality Review Boards show that 53% of deaths occur between one week and one year after giving birth, partly due to mental health factors leading to drug overdose and suicide. Evidence suggests recent improvement in care at delivery, but postpartum care is more difficult to address.
- Pregnancy-related deaths increased during the pandemic. The NCHS reported that maternal deaths peaked at 1,205 in 2021, with racial and ethnic minorities disproportionately harmed.
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