October 27, 2022 JAMA: More than 4 in 5 Pregnancy-Related Deaths in the US Are Preventable

On October 27, 2022, the Journal of the American Medical Association published an article about a recent CDC report of pregnancy-related deaths that showed about 700 patients die each year as a result of pregnancy or its complications. The article highlights some other alarming features in the data reported:

According to the article:

“The data also highlight persistent racial disparities. Almost half of maternal deaths were among White individuals. But 31% occurred among Black individuals, who represent only 14% of the US population.

Moreover, the leading causes of death varied by race and ethnicity. Cardiac and coronary conditions were the leading cause of death among Black people. Mental health conditions were the primary cause of death among Hispanic and White people. And hemorrhage contributed the largest proportion of deaths among Asian people.

“This points to implicit bias and racism, not race, as the causes of disparities in maternal care,” Amelia Cobb, MPH, the CHCF’s senior program officer of People-Centered Care and Learning Impact teams, said in an interview.

She noted that the high rate of cardiac deaths and deaths after the postpartum period are consistent with news reports about deaths or near misses among Black parents across the country who sought help for postpartum complications but had their concerns ignored or minimized. For example, a 2017 investigation by NPR and ProPublica that collected 200 Black women’s stories detailed symptoms of serious cardiovascular conditions during pregnancy or postpartum not being taken seriously or properly addressed.

In 2018, the CHCF’s Listening to Mothers in California report found that about 1 in 10 Black patients said they experienced mistreatment because of their race or ethnicity compared with about 1 in 100 White people. About 10% of Black patients reported rough handling and rude or threatening language, compared with about 8% of White patients. Those who spoke a language other than English also reported elevated rates of mistreatment compared with White patients. About 1 in 5 Black patients said they felt pressured to have a cesarean delivery, about twice the number of White patients who reported such pressure, and 42% of Black patients had the procedure compared with 29% of White patients.”

The CDC Data shows the following:

“Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2016–2018, the pregnancy-related mortality ratios (PRMRs) were:

  • 41.4 deaths per 100,000 live births for non-Hispanic Black persons.
  • 26.5 deaths per 100,000 live births for non-Hispanic American Indian or Alaska Native persons.
  • 14.1 deaths per 100,000 live births for non-Hispanic Asian or Pacific Islander persons.
  • 13.7 deaths per 100,000 live births for non-Hispanic White persons.
  • 11.2 deaths per 100,000 live births for Hispanic persons.

“In 2018, the PRMR was 9.5 deaths per 100,000 live births for non-Hispanic multiple race persons.

“Variability in the risk of death by race/ethnicity may be due to several factors including access to care, quality of care, prevalence of chronic diseases, structural racism, and implicit biases.

And,

“[P]regnancy-related deaths in the United States during 2016–2018 [were] caused by:

  • Other cardiovascular conditions, 16.2%.
  • Infection or sepsis, 13.9%.
  • Cardiomyopathy, 12.5%.
  • Hemorrhage, 11.0%.
  • Thrombotic pulmonary or other embolism, 9.4%.
  • Cerebrovascular accidents, 7.0%.
  • Hypertensive disorders of pregnancy, 6.8%.
  • Amniotic fluid embolism, 5.7%.
  • Anesthesia complications, 0.2%.
  • Other noncardiovascular medical conditions, 11.4%.

“The cause of death is unknown for 6.0% of all 2016–2018 pregnancy-related deaths.

“While the contributions of hemorrhage, hypertensive disorders of pregnancy (i.e., preeclampsia, eclampsia), and anesthesia complications to pregnancy-related deaths declined, the contributions of cardiovascular, cerebrovascular accidents, and other medical conditions increased. Studies show that an increasing number of pregnant persons in the United States have chronic health conditions such as hypertension,diabetes, and chronic heart disease. These conditions may put a person at higher risk of complications during pregnancy or in the year postpartum. Causes of and risk factors for pregnancy-related deaths between 1987 and 2016 have been published.

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“During 2016-2018, the PRMRs were:

  • 15.7 deaths per 100,000 live births for persons living in large central metro counties.
  • 13.8 deaths per 100,000 live births for persons living in large fringe metro counties.
  • 16.3 deaths per 100,000 live births for persons living in medium metro counties.
  • 17.9 deaths per 100,000 live births for persons living in small metro counties.
  • 19.5 deaths per 100,000 live births for persons living in micropolitan counties.
  • 24.4 deaths per 100,000 live births for persons living in noncore counties.

“A prior study found that PRMRs were higher in noncore (the most rural categorization) counties when compared to metropolitan counties. Variability in the risk of death by geographic location groups might reflect chronic health conditions and access to care (e.g., rural residents may face challenges such as distance from and lack of access to obstetric services and providers) including risk-appropriate care.

Remarkably, the data showed that racial disparities in maternal mortality were not caused by race, but were caused by disparity in the way the patients were treated by healthcare providers.

Girards Law Firm pursues cases for patients injured or killed by medical mismanagement. Call us to discuss your possible case at 214-346-9529 or by sending an email to [email protected]

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