“There was a lot of alarm and concern around the fact that some of these reports showed a three-fold increase in maternal mortality, which is not what we found. The incidence is low and stable. KS Joseph, lead author of the study and a professor in the Department of Obstetrics and Gynecology and Population and Public Health at the University of British Columbia in Vancouver.
21 years ago, the way pregnancy is recorded on death certificates changed. Attempts to improve the detection of maternal deaths led to “significant misclassification” and “overestimation of maternal mortality rates,” the study found.
In 2003, the National Vital Statistics System added a checkbox on death certificates to indicate whether the deceased was pregnant or had recently become pregnant, to address concerns that pregnancy-related deaths were undercounted. did.
But the box was checked for many deaths unrelated to pregnancy or childbirth, the researchers found. For example, hundreds of deaths over the age of 70 were incorrectly classified as pregnant. If the box is checked, deaths from cancer and other causes are also counted as maternal deaths. as a result, mother’s Mortality rates have increased dramatically since 2003.
Researchers noted that large racial disparities remain, especially between white and black pregnant women. Black pregnant women have higher rates of pregnancy complications such as ectopic pregnancy and eclampsia, as well as chronic conditions such as high blood pressure, heart disease, and kidney failure, resulting in nearly three times the mortality rate of white pregnant women. was discovered by researchers.
Some experts say the study’s biggest takeaway is the deep racial disparity in pregnant women who are overrepresented in black women. Medical complications such as caesarean section, postpartum hemorrhage, and premature birth are on the rise. No matter how the data is calculated, the pattern remains the same, says Colleen Denney, associate professor of obstetrics and gynecology and director of family planning at New York University Langone Hospital and fellow of the American College of Obstetricians and Gynecologists. .
“We should target a lot of our public outreach efforts to focus on conditions that affect patients of color during pregnancy,” said Denny, who was not involved in the study. said.
Joseph previously noted the soaring maternal mortality rate in the United States in a 2017 paper, stating: “Many maternal deaths, perhaps more than half of maternal deaths, are preventable, so we need to address these specific causes of death and initiate programs to prevent them.”
The new study was prompted by researchers’ confusion about why maternal mortality rates in the U.S. are so high compared to other high-income countries, said Kande Ananth, the study’s senior author and principal investigator. he said. in Epidemiology and Biostatistics from Rutgers Robert Wood Johnson Medical School. The authors stated that maternal mortality rates in the United States are actually comparable to those in Canada and the United Kingdom. But even with adjusted rates, U.S. interest rates will remain higher than most of their peers.
The authors chose to ignore the checkbox and only count deaths where pregnancy-related causes were listed.
Under the new standards, researchers They found that the mortality rate was 10.2 deaths per 100,000 live births from 1999 to 2002, and 10.4 deaths from 2018 to 2021. In contrast, the National Vital Statistics System methodology showed a mortality rate of 9.65 deaths from 1999 to 2002 and 23.6 deaths from 2018 to 2021.
An agency spokesperson declined to comment on the new study, instead pointing to the agency’s own 2018 report.
In this report, the National Vital Statistics System reviewed several studies in which it was found that pregnancy and childbirth checkboxes were incorrectly used, particularly for people aged 45 and older.A report by the authorities at the time stated that without the checkbox, the maternal mortality rate would be It has remained flat since 2002.
To correct the misuse of the checkbox, authorities changed the way they counted deaths. We no longer classify deaths in people aged 44 and over as pregnancy-related unless there is a specific cause of death related to pregnancy or childbirth. But for people under 44, authorities continued to classify all deaths that checked the box as pregnancy- or childbirth-related, even if the specific cause of death was unrelated.
Despite the study’s conclusion that the use of checkboxes led to excessively high calculations of maternal mortality rates, the National Vital Statistics System in its 2018 report recommended that checkboxes be used to avoid undercounting maternal mortality rates. He said he would continue calculating the percentage from
Other experts say the new research could help expand how public health efforts can be targeted to produce better outcomes.
This is an opportunity to rethink how the country tracks maternal health and create a better system for identifying problems and interventions, said Dr. said Chiamaka Onwuzurike, a lecturer at Harvard Medical School. Involved in research. “What good does it actually do to keep on blindfolded and think things are working well and the systems are tracking properly?”
In 2022, the White House released a blueprint to address the maternal health crisis, outlining federal actions and long-term improvement goals. But the federal government must: Progress toward achieving these goals can be better tracked, according to a February report from the Government Accountability Office.
According to Amita Vyas, professor in the Department of Preventive and Community Health and director at George Washington University, examining indirect causes of maternal deaths, including mental health, can help minimize instances of non-obstetric causes of death. This could lead to targeted policies and interventions. University Maternal and Child Health Center of Excellence.
“When we think about maternal mortality, it’s not just during pregnancy and childbirth,” Vyas says. “Ignoring other indirect pregnancy-related factors during the puerperium precludes the ability to plan life-saving interventions.”
