Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999

1) to report Massachusetts pregnancy-associated mortality ratios (PAMRs) and maternal mortality ratios (MMRs) from 1990 to 1999 and pregnancy-related mortality ratios (PRMRs) from 1995 to 1999; 2) to identify disparities in PAMRs by race and Hispanic ethnicity, payer at delivery, age, and age by medical and injury cause of death; 3) to report distributions of pregnancy-associated deaths by cause, preventability, and timing in relation to pregnancy.

Pregnancy-associated deaths from 1990 to 1999 were identified using enhanced methods, including linkage of vital records. Preventability and pregnancy relatedness were determined by case review (1995-1999). Trends in ratios and aggregate PAMRs by key characteristics were calculated.

The 10-year PAMR and MMR were 27.2 and 3.3 per 100,000 live births, respectively, with no significant changes from 1990 to 1999. The PRMR was 6.1 for 1995 to 1999. The leading cause of pregnancy-associated death was homicide. The PAMRs for black non-Hispanic and Hispanic women were 3.1 and 1.8 times higher than that for white non-Hispanic women. The PAMR was 3.2 times higher for women with public than with private payers and 3.4 times higher among women age 40 to 44 than among women age 25 to 39. The injury PAMR for women younger than 25 was 3 times higher than it was for women age 25 to 39. Injuries caused one-third of pregnancy-associated deaths. Fifty-four percent of deaths from 1995 to 1999 were deemed preventable.

Pregnancy-associated deaths are rare, yet many are preventable. Public health prevention strategies should extend beyond the traditional postpartum period and address disparities for black non-Hispanic and Hispanic women, low-income women, older women for medical causes, and younger women for injury causes.