Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations

K. S. Joseph, Amélie Boutin, Sarka Lisonkova, Giulia M. Muraca, Neda Razaz, Sid John, Azar Mehrabadi, Yasser Sabr, Cande V. Ananth, Enrique Schisterman

Résultat de recherche: Articleexamen par les pairs

102 Citations (Scopus)

Résumé

Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns. Although the National Center for Health Statistics studies, based on recoding of death certificate information (after excluding information from the pregnancy checkbox), showed that crude maternal mortality rates did not change significantly between 2002 and 2018, age-adjusted analyses show a temporal reduction in the maternal mortality rate (21% decline, 95% CI 13-28). Specific causes of maternal death, which were not affected by the pregnancy checkbox, such as preeclampsia, showed substantial temporal declines. However, large racial disparities continue to exist: Non-Hispanic Black women had a 2.5-fold higher maternal mortality rate compared with non-Hispanic White women in 2018. This overview of maternal mortality underscores the need for better surveillance and more accurate identification of maternal deaths, improved clinical care, and expanded public health initiatives to address social determinants of health. Challenges with ascertaining maternal deaths notwithstanding, several causes of maternal death (unaffected by surveillance artifacts) show significant temporal declines, even though there remains substantial scope for preventing avoidable maternal death and reducing disparities.

Langue d'origineEnglish
Pages (de-à)763-771
Nombre de pages9
JournalObstetrics and Gynecology
Volume137
Numéro de publication5
DOI
Statut de publicationPublished - mai 1 2021

Note bibliographique

Publisher Copyright:
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

ASJC Scopus Subject Areas

  • Obstetrics and Gynaecology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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