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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Daniel B. Nelson, Michelle H. Moniz, Matthew M. Davis

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

In 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.

Methods

We 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.

Results

Maternal 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%).

Conclusions

Our 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.
Appendix
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Literature
1.
Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987-1990. Obstet Gynecol. 1996;88(2):161–7.CrossRefPubMed
2.
Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015;125(1):5–12.CrossRefPubMed
3.
MacDorman MF, Declercq E, Cabral H, Morton C. Recent increases in the US maternal mortality rate disentangling trends from measurement issues. Obstet Gynecol. 2016;128(3):447–55.CrossRefPubMedPubMedCentral
4.
5.
Nannini A, Weiss J, Goldstein R, Fogerty S. Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999. J Am Med Womens Assoc. 2002;57(3):140–3.
6.
Main EK, McCain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol. 2015;125(4):938–47.CrossRefPubMed
7.
Geller SE, Koch AR, Martin NJ, Rosenberg D, Bigger HR, Illinois Department of Public Health Maternal Mortality Review Committee Working G. Assessing preventability of maternal mortality in Illinois: 2002–2012. Am J Obstet Gynecol. 2014;211(6):698 e691–11.CrossRef
8.
Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199(1):36 e31–5. discussion 91–32 e37–11CrossRef
9.
Berg CJ, Harper MA, Atkinson SM, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005;106(6):1228–34.CrossRefPubMed
10.
Wang Y, Tanbo T, Abyholm T, Henriksen T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet. 2011;284(1):31–7.CrossRefPubMed
11.
King JC. Maternal mortality in the United States--why is it important and what are we doing about it? Semin Perinatol. 2012;36(1):14–8.CrossRefPubMed
12.
Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol. 2012;36(1):2–6.CrossRefPubMed
13.
MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293–307. vCrossRefPubMed
14.
Creanga AA, Bateman BT, Kuklina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008–2010. Am J Obstet Gynecol. 2014;210(5):435 e431–8.CrossRef
15.
National Center for Health Statistics. Maternal mortality and related concepts. Hyattsville: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2007.
16.
Davis GG, Onaka AT. Report on the 2003 revision of the US standard certificate of death. Am J Foren Med Path. 2001;22(1):38–42.CrossRef
17.
MacKay AP, Berg CJ, Liu X, Duran C, Hoyert DL. Changes in pregnancy mortality ascertainment: United States, 1999-2005. Obstet Gynecol. 2011;118(1):104–10.CrossRefPubMed
18.
Campbell KH, Savitz D, Werner EF, et al. Maternal morbidity and risk of death at delivery hospitalization. Obstet Gynecol. 2013;122(3):627–33.CrossRefPubMed
19.
Frolich MA, Banks C, Brooks A, Sellers A, Swain R, Cooper L. Why do pregnant women die? A review of maternal deaths from 1990 to 2010 at the University of Alabama at Birmingham. Anesth Analg. 2014;119(5):1135–9.CrossRefPubMed
20.
Goffman D, Madden RC, Harrison EA, Merkatz IR, Chazotte C. Predictors of maternal mortality and near-miss maternal morbidity. J Perinatol. 2007;27(10):597–601.CrossRefPubMed
21.
22.
James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194(5):1311–5.CrossRefPubMed
23.
Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, System UKOS. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol. 2010;115(5):989–97.CrossRefPubMed
24.
Metsala J, Stach-Lempinen B, Gissler M, Eriksson JG, Koivusalo S. Risk of pregnancy complications in relation to maternal Prepregnancy body mass index: population-based study from Finland 2006-10. Paediatr Perinat Epidemiol. 2016;30(1):28–37.CrossRefPubMed
25.
Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol. 2015;125(1):133–43.CrossRefPubMedPubMedCentral
26.
Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091–7.CrossRefPubMed
27.
28.
Hernandez L, Sappenfield W, Burch D. 1999–2008 Florida pregnancy-related mortality report: why are Florida mothers continuing to die. Tallahassee: Florida Department of Health; 2010.
29.
Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. The N Engl J Med. 2016;374(9):843–52.CrossRefPubMed
30.
31.
Alexander GR, Kogan MD, Nabukera S. Racial differences in prenatal care use in the United States: are disparities decreasing? Am J Public Health. 2002;92(12):1970–5.CrossRefPubMedPubMedCentral
32.
Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202(4):335–43.CrossRefPubMedPubMedCentral
33.
Horon IL, Cheng D. Effectiveness of pregnancy check boxes on death certificates in identifying pregnancy-associated mortality. Public Healht Rep. 2011;126(2):195–200.CrossRef
34.
Saucedo M, Bouvier-Colle MH, Chantry AA, Lamarche-Vadel A, Rey G, Deneux-Tharaux C. Pitfalls of national routine death statistics for maternal mortality study. Paediatr Perinat Epidemiol. 2014;28(6):479–88.CrossRefPubMed
35.
MacDorman MF, Declercq E, Thoma ME. Trends in maternal mortality by sociodemographic characteristics and cause of death in 27 states and the District of Columbia. Obstet Gynecol. 2017;129(5):811–8.CrossRefPubMedPubMedCentral
36.
Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5):1029–36.PubMed
37.
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, et al. Underreporting of pregnancy-related mortality in the United States and Europe. Obstet Gynecol. 2005;106(4):684–92.CrossRefPubMed
Metadata
Title
Population-level factors associated with maternal mortality in the United States, 1997–2012
Authors
Daniel B. Nelson
Michelle H. Moniz
Matthew M. Davis
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5935-2

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