Causes contributing to the excess maternal mortality risk for women 35 and over, United States, 2016–2017

Abstract

To better understand age-related disparities in US maternal mortality, we analyzed 2016–2017 vital statistics mortality data with cause-of-death literal text (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths which had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. Age-related disparities were examined both overall and by primary cause. Compared to women <35, the 2016–2017 US maternal mortality rate was twice as high for women aged 35–39, four times higher for women aged 40–44, and 11 times higher for women aged 45–54 years. Obstetric hemorrhage was the leading cause of death for women aged 35+ with rates 4 times higher than for women <35, followed by postpartum cardiomyopathy with a 3-fold greater risk. Obstetric embolism, eclampsia/preeclampsia, and Other complications of obstetric surgery and procedures each had a two-fold greater risk of death for women aged 35+. Together these 5 causes of death accounted for 70.9% of the elevated maternal mortality risk for women aged 35+. The excess maternal mortality risk for women aged 35+ was focused among a few causes of death and much of this excess mortality is preventable. Early detection and treatment, as well as continued care during the postpartum year is critical to preventing these deaths. The Alliance for Innovation on Maternal Health has promulgated patient safety bundles with specific interventions that health care systems can adopt in an effort to prevent these deaths.

Sustainability in Transformation of Maternal Mortality by Interaction Based Approach in Dairi, Indonesia

“… 23 , 24 It was found that the risk of increased maternal mortality for women aged 35 and up was concentrated in a few causes of death, and much of this excess mortality can be avoided. 25 , 26 In connection with the results of this study, the promotional efforts can be carried out in addition to forming good behavior attitudes. Therefore it is also very important to pay attention to the knowledge factor of pregnant women by carrying out health promotion strategies by empowering health cadres, so that the intentions of the pregnant women can be strengthened by adding more knowledge regarding mother's pregnancy care.…”

Maternal death in Iceland 1976-2015

“…11 Maeðradauði eykst með haekkandi aldri maeðra. 12 Laekkun maeðradauða er eitt af átta þúsaldarmarkmiðum Sameinuðu þjóðanna. 2,6,8 Talsverður árangur hefur náðst, en ekki fullnaegjandi í löndum sem eru verst sett.…”

Optimizing postpartum contraception for high-risk obstetric patients

“…People are waiting longer into adulthood to conceive. Compared to pregnant people younger than age 35, the 2016–2017 US maternal mortality rate was twice as high for those aged 35–39, four times higher for those aged 40–44, and 11 times higher for those aged 45–54 years [13 ▪ ]. While age is not necessarily modifiable, targeting the chronic medical conditions that are contributing to increased risk of morbidity for older pregnant people is important to address.…”