More than 80% of pregnancy-related deaths between 2017 and 2019 were preventable, according to a recent analysis from CDC published in the Morbidity and Mortality Weekly Report, with mental health conditions causing nearly a quarter of those deaths.

Report details

For the report, CDC reviewed pregnancy-related death data from 36 states between 2017 and 2019. Out of the total 996 deaths that occurred during that time where a preventability determination was made, CDC found that 84.2% were preventable.

Among the deaths that had information on timing, 22% of deaths occurred during pregnancy, 25% occurred within seven days of delivery, and 53% occurred between one week and one year after pregnancy.

The leading cause of death was mental health conditions, including drug overdoses, which accounted for 22.7% of deaths. Hemorrhage was the second-leading cause of death at 13.7%, followed by coronary conditions at 12.8%.

The report found that non-Hispanic Black Americans were disproportionately affected by pregnancy-related deaths, comprising 13.8% of the U.S. population but 31.4% of pregnancy-related deaths.

Discussion

According to Wanda Barfield, director of CDC's Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion, the report "paints a much clearer picture of pregnancy-related deaths in this country."

"The majority of pregnancy-related deaths were preventable, highlighting the need for quality improvement initiatives in states, hospitals, and communities that ensure all people who are pregnant or postpartum get the right care at the right time," she said.

Allison Bryant, a high-risk obstetrician and senior medical director for health equity at Massachusetts General Hospital, said the report is "significant. It's staggering. It's heartbreaking. It just means that we have so much work to do."

Andrea Jackson, division chief of obstetrics and gynecology at the University of California, San Francisco, noted that there are toolkits for clinicians to use that provide evidence-based guides on preventing and treating hemorrhage.

"No pregnant person should be passing away from a hemorrhage," she said. "We have the tools in the United States and we know how to deal with it. That was really disheartening to see."

Charletta Ayers, an obstetrician and gynecologist and director of the Division of OB-GYN at Rutgers University Robert Wood Johnson Medical School, said the report was "sobering" and emphasizes the need for better mental health resources for both pregnant and post-partum women to avoid them falling "under the radar."

Similarly, Lethenia Baker, an OB-GYN at Wellstar Health, noted there can be a "long delay in diagnosis and in treatment" of postpartum conditions, and that structural improvements in diagnosis, access to care, and awareness are necessary.

"These are things that need to happen systemically," she said. "It can't just be a few practices here or there who are adopting best practices. It has to be a systemic change." (Folmar, The Hill, 9/19; AHA News, 9/19; Hassanein, USA Today, 9/19; Gonzalez, Axios, 9/20)