Pregnancy-Related Deaths Still Higher With Some Minorities

THURSDAY, Sept. 5, 2019 — Pregnancy is a far riskier undertaking for many minority women than it is for white women in the United States, a new government study shows.

The chances of dying from pregnancy complications is two to three times higher for black, American Indian and Alaska Native women than it is for white women.

“These disparities are devastating for families and communities, and we must work to eliminate them,” said lead author Dr. Emily Petersen, medical officer in the Division of Reproductive Health at the U.S. Centers for Disease Control and Prevention.

“There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths,” Petersen said in a CDC news release.

Her team analyzed national data from 2007-2016 and found that the overall rate of pregnancy-related deaths rose from 15 to 17 per 100,000 births during that time.

By racial/ethnic group, rates were 40.8 per 100,000 births for blacks, 29.7 for American Indians/Alaska Natives, 13.5 for Asian/Pacific Islanders, 12.7 for whites, and 11.5 for Hispanics.

The gap between blacks and American Indians/Alaska Natives and other racial and ethnic groups widened with age. Among women older than 30, rates among blacks and American Indians/Alaska Natives were four to five times higher than among whites.

The study also found that the rate among blacks with at least a college degree was just over five times higher than among whites with at least a college degree.

Cardiomyopathy, pulmonary embolism, and high blood pressure disorders of pregnancy were factors in more pregnancy-related deaths among blacks than among whites. Hemorrhage and high blood pressure disorders of pregnancy were factors in more pregnancy-related deaths among American Indians/Alaska Natives than among whites.

There was little change in racial/ethnic disparities between 2007 and 2016, according to the study published Sept. 6 in the CDC’s Morbidity and Mortality Weekly Report.

Most pregnancy-related deaths are preventable, according to the agency.

The CDC defines a pregnancy-related death as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy.”

A CDC report from May that analyzed data from 13 states concluded that each pregnancy-related death was associated with several contributing factors. These included lack of access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and health care providers about warning signs.

The data suggested that 60% or more of pregnancy-related deaths could have been prevented by correcting these issues.

“There are many complex drivers of [pregnancy-related death]. This [new study] shows the critical need to accelerate efforts and to identify the initiatives that will be most effective,” said Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health.

More information

The U.S. Office on Women’s Health has more about pregnancy complications.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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Many Pregnancy-Related Maternal Deaths Occur Months After Delivery: CDC

TUESDAY, May 7, 2019 — Too many women still die from pregnancy-related causes, some up to a year after delivery, according to a new report from the U.S. Centers for Disease Control and Prevention.

About 700 pregnancy-related deaths occur in the United States each year, and 3 out of 5 are preventable, data show.

Nearly 31% of the deaths happen during pregnancy, and another 36% occur during delivery or the week after.

But a full third of deaths happen up to a year after a woman gives birth, the CDC found.

“These are women in their prime who leave loved ones behind often stunned at what has happened,” CDC Principal Deputy Director Dr. Anne Schuchat said at a media briefing.

For the study, the CDC analyzed national data on pregnancy-related deaths between 2011 and 2015, and more detailed data from 13 states gathered between 2013 and 2017.

The CDC defines pregnancy-related death as one occurring within a year of the pregnancy’s end. The cause could be a related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated medical condition by pregnancy.

Heart disease and stroke caused about 1 in 3 deaths, researchers found. Other leading causes included infections and severe blood loss.

“Our new analysis underscores the need for access to quality services, risk awareness and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths,” said Dr. Wanda Barfield, director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives,” Barfield said in an agency news release.

The cause of death generally depends on timing, the CDC noted:

  • Obstetric emergencies such as severe bleeding caused most deaths during delivery.
  • In the week after delivery, new mothers were more likely to die from high blood pressure, infection and severe blood loss.
  • A weakened heart muscle (cardiomyopathy) caused most deaths up to a year after delivery.

These deaths were associated with several factors related to prenatal care, CDC said.

In some cases, women died because they lacked access to good health care, resulting in delayed or missed diagnoses of crucial medical problems. Women and their health care providers also appeared to lack knowledge about the warning signs of a troubled pregnancy, according to the report.

Serious racial disparities also exist. Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women.

CDC officials said the data suggest that the majority of deaths, regardless of when they occurred, could have been prevented by tackling these key problems:

  • Providers can better help patients manage chronic conditions and teach them warning signs.
  • Hospitals and health systems can coordinate efforts between providers and support efforts to improve care during and after pregnancy.
  • States and communities can develop policies that improve access to care and ensure that women at high risk can give birth at hospitals with special training and equipment for troubled pregnancies.

“Making some of these improvements will not be easy. It could require reworking systems that have been in place for years,” Schuchat said. “The good news, though, is that there are already systematic approaches being developed and implemented in many areas around the country that can be used as a model to support improvements to save the lives of women.”

Dr. Megan Gray, an obstetrician-gynecologist at Orlando Health Winnie Palmer Hospital for Women and Babies in Florida, said obstetricians and nurse-midwives have work to do.

“It is crucial that hypertensive disorders during and after pregnancy, infections, sepsis, hemorrhage and cardiomyopathy be recognized early and promptly managed,” she said. “This includes educating patients about early warning signs and providing pregnant women with access to quality care.”

Gray said women should be seen sooner and more often after pregnancy than the standard six weeks after delivery, so that complications can be detected and addressed.

CDC Director Dr. Robert Redfield said ensuring quality care for mothers during and after pregnancy should be among the nation’s top priorities.

“I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives,” Redfield said in the release.

The study appears in the CDC’s Morbidity and Mortality Weekly Report.

More information

The U.S. Office on Women’s Health has more about pregnancy complications.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

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Heart Disease No. 1 Cause of Pregnancy-Related Deaths in California: Study

SUNDAY Nov. 17, 2013, 2013 — Heart disease is the top cause of pregnancy-related deaths in California, but almost one-third of those deaths could be prevented, a new study suggests.

“Women who give birth are usually young and in good health. So heart disease shouldn’t be the leading cause of pregnancy-related deaths, but it is,” lead researcher Dr. Afshan Hameed, an associate professor of clinical cardiology, obstetrics and gynecology at the University of California, Irvine, said in an American Heart Association (AHA) news release.

From 2002 to 2005, there were 2.1 million live births in California. Hameed and her colleagues analyzed the medical records of 732 women in the state who died from all causes while pregnant or within one year of pregnancy, and found that 209 of those deaths were pregnancy-related.

About one-quarter (52) of the pregnancy-related deaths were from some form of heart disease. Only 6 percent of these women who died had been diagnosed with a heart condition before the pregnancy.

Two-thirds (33) of the heart-related deaths were from cardiomyopathy, a disease in which the heart muscle is weakened and that can lead to heart failure, irregular heartbeats, heart valve problems and death.

Women most likely to die from pregnancy-related heart disease were black, obese or were substance abusers during pregnancy. Nearly one-fourth of the pregnant women who died of heart disease had been diagnosed with high blood pressure during their pregnancies.

In about two-thirds of the deaths, the diagnosis was either incorrect or delayed or doctors gave ineffective or inappropriate treatments, according to the researchers. One-third of the patients who died had failed to seek or had delayed care, 10 percent refused medical advice and 27 percent did not recognize their symptoms as heart-related.

The findings, scheduled for presentation Sunday at the AHA’s annual meeting in Dallas, likely apply to the rest of the United States, according to Hameed.

“Women should attain and maintain proper weight before and during pregnancy, and talk to their doctors if they have personal or family histories of heart disease,” she said.

“And health care providers should be referring pregnant women who complain of symptoms consistent with cardiac disease to specialists, especially when these risk factors are present. Women with evidence of substance abuse should receive early referral for treatment,” Hameed added.

However, it is impossible to be certain whether earlier diagnosis and intervention would have prevented death in these cases “as missed cues to the presence of heart disease were common,” she said.

Because the study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Maternal death rates have been rising in California and the United States since the mid-1990s, according to the California Department of Public Health.

More information

The Cleveland Clinic has more about heart diseases and pregnancy.

Posted: November 2013

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