Population-level factors associated with maternal mortality in the United States, 1997–2012

Abstract

BackgroundIn contrast to peer nations, the United States is experiencing rapid increases in maternal mortality. Trends in individual and population-level demographic factors and health trends may play a role in this change.MethodsWe analyzed state-level maternal mortality for the years 1997–2012 using multilevel mixed-effects regression grouped by state, using publicly available data including whether a state had adopted the 2003 U.S. Standard Certificate of Death, designed to simplify identification of pregnant and recently pregnant decedents. We calculated the proportion of the increase in maternal mortality attributable to specific factors during the study period.ResultsMaternal mortality was associated with higher population prevalence of obesity and high school non-completion among women of childbearing age; these factors explained 31.0% and 5.3% of the attributable increase in maternal mortality during the study period, respectively. Among delivering mothers, prevalence of diabetes (17.0%), attending fewer than 10 prenatal visits (4.9%), and African American race (2.0%) were also associated with higher maternal mortality, as was time-varying state adoption of the 2003 death certificate (31.1%).ConclusionsOur findings indicate that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5935-2) contains supplementary material, which is available to authorized users.

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

“…However, adolescent pregnancy was not a risk factor for maternal mortality after adjusting the confounding factors. The increase in maternal mortality during adolescent pregnancy was related to the social factors such as maternal poverty and education [40], and the lack of medical resources may also affect maternal mortality [41]. After structural equation model analysis, we also found that preterm delivery and cesarean delivery had an indirect effect on the correlation between adolescent pregnancy and neonatal death.…”

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China

“…However, adolescent pregnancy was not a risk factor for maternal mortality after adjusting the confounding factors. The increase in maternal mortality during adolescent pregnancy was related to the social factors such as maternal poverty and education [39], and the lack of medical resources may also affect maternal mortality [40]. After structural equation model analysis, we also found that preterm delivery and cesarean delivery had an indirect effect on the correlation between adolescent pregnancy and neonatal death.…”

Maternal Mortality in Tajikistan: Successes and Challenges

“…They are one of the leading causes of maternal mortality in Tajikistan. Chronic health diseases increase risks of complications before, during and after childbirth as studies in other research settings reported [1,4,5,[23][24][25][26][27][28][29]. The critical aspect of this study is that it highlights the obstetric transition which according to Souza, et al a shift from direct causes to indirect causes of maternal mortality that occurs when maternal mortality decreases in countries which experienced high maternal mortality in the past [29,30].…”