The U.S. maternal mortality rate is lower than previously estimated, according to a study published in the journal Today. Journal of the American College of Obstetricians and Gynecologists March 13, 2024.
Researchers said inaccurate record-keeping was causing unwarranted alarm that an increasing number of women were dying during pregnancy or shortly after giving birth. They report that maternal mortality rates are stable and deaths from obstetric complications are decreasing.
“Obstetric complications as a cause of death have decreased over time, which is to be expected as medical care has improved,” said Dr. said physician KS Joseph, MD. , Canada, and co-author of the new study.
This good news comes with a solemn asterisk. The country's maternal mortality rate remains the highest in the developed world, and black women in the United States are far more likely to die during or after pregnancy than women of other races and ethnicities.
“Whenever there is a disparity, it always boils down to two things: implicit bias and systemic It's racism.”
Gillispie-Bell said systemic racism leads to economic insecurity, poor access to health care, and fuels downstream harms such as higher maternal mortality rates for black women. And implicit bias manifests itself in discriminatory and potentially painful treatment of Black women without doctors even realizing they're doing it, she added.
Different counting methods, different results
In 2003, National Center for Health Statistics (NCHS) officials recommended adding a “pregnancy checkbox” to U.S. death certificates to address undercounting of deaths due to pregnancy complications. This checkbox indicates whether the deceased woman was pregnant at the time of death, within 42 days of death, within one year from 43 days before death, not pregnant, or if this information is unknown. Indicates whether there is
The fact that someone was pregnant at the time of death does not mean that pregnancy was the cause. However, as reported by Joseph et al., under NCHS guidelines, any death of a woman whose certificate states she is pregnant is counted as a “maternal death.” From 2003 until her 2017, this classification applied regardless of age at death. Since 2018, only women who died during childbearing age (15 to 44 years) are eligible. NCHS made this change to reduce the number of deaths inaccurately attributed to pregnancy, Joseph said.
The checkbox method has shown that between 1999 and 2002 (9.65 per 100,000 live births) and between 2018 and 2021 (23.6 per 100,000 live births), the maternal mortality rate for women aged 15 to 44 was 144 It is said to have increased by %.
Joseph and his colleagues also looked for death certificates that included a clear cause of death and the fact that she was pregnant. For these deaths to be linked to pregnancy, they must be associated with obstetric complications that occurred during pregnancy, or with an underlying disease or condition that worsened during pregnancy.
Using this refinement, researchers determined that from 1999 to 2002 there were 10.2 maternal deaths per 100,000 live births, and from 2018 to 2021 there were 10.4 maternal deaths per 100,000 live births. . Deaths from direct obstetric causes decreased. Indirect causes of maternal death, such as cardiomyopathy, pre-existing hypertension, and increased placenta attached to the uterine wall.
“The alternative method we used was one that focused on actual maternal deaths,” Joseph said.
For black women, the alternative method showed 25.7 deaths per 100,000 live births from 1999 to 2002 and 23.8 deaths per 100,000 live births from 2018 to 2021. Both numbers were twice the overall death rate, and black women were also more likely to experience conditions such as high blood pressure and cardiomyopathy. , according to the researchers.
Gillispie Bell is the medical director of the Louisiana Pregnancy-Related Deaths Commission, which scrutinizes death records to compile accurate maternal death statistics for the state.
“The Maternal Mortality Commission is extremely important because it is reviewing and verifying the data,” Gillispie-Bell said. And the process also shows disparities in maternal mortality rates between Black women and other American women, Gillispie-Bell said.
One strategy to address this gap, endorsed by both Joseph and Gillispiebel, is to intensively monitor all signs of hypertension and cardiomyopathy in pregnant black women as soon as they appear. It is important to treat the symptoms. Dr. Gillispie-Bell also recommends that clinicians take the Implicit Association Test to find out if they are unconsciously bringing bias into their interactions with Black women and change their behavior when warranted. proposed to make it possible.
“Our brains use shortcuts to process information,” Gillispie-Bell says. “This is how prejudice happens. No one should feel guilty about it.”
Joseph received an Investigator Award from the BC Children's Hospital Research Institute. Gillispie Bell has nothing.
Marcus A. Banks, MA, is a New York City-based journalist who covers health news with a focus on new cancer research. His work has appeared in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.