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Maternal Cardiovascular Mortality in Illinois, 2002-2011
Joan Briller1, Abigail R Koch, Stacie E Geller
1Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois.
Insights
Cardiovascular disease caused over one-fifth of maternal deaths in Illinois from 2002-2011. Nearly 30% of these deaths were preventable, highlighting the need for improved healthcare provider and patient factors.
Area of Science:
- Public Health
- Cardiology
- Obstetrics & Gynecology
Background:
- Cardiovascular disease (CVD) is a leading cause of maternal mortality globally.
- Understanding the specific demographic characteristics and etiologies of CVD-related maternal deaths is crucial for targeted interventions.
- Pregnancy can exacerbate pre-existing or undiagnosed cardiovascular conditions.
Purpose of the Study:
- To describe the demographic profile of women in Illinois who died from cardiovascular disease during pregnancy or up to one year postpartum.
- To identify the specific causes (etiologies) and timing of these cardiovascular deaths.
- To determine the proportion of potentially preventable cardiovascular maternal deaths and associated contributing factors.
Main Methods:
- Retrospective analysis of maternal deaths in Illinois from 2002 to 2011.
- Data sourced from the Illinois Department of Public Health Maternal Mortality Review process.
- International Classification of Diseases, 9th Revision (ICD-9) codes were used to identify cardiovascular disease as the cause of death.
Main Results:
- Cardiovascular disease accounted for 22.2% of maternal deaths in Illinois (8.2 per 100,000 live births).
- Women experiencing cardiovascular mortality were often older and deaths occurred postpartum.
- Leading causes included cardiomyopathy (27.9%), stroke (22.9%), and hypertensive disorders (12.9%).
- Nearly 75% of cardiac deaths were pregnancy-related, compared to 35.3% of non-cardiac deaths.
- Approximately 28.1% of cardiovascular maternal deaths were deemed potentially preventable.
Conclusions:
- Cardiovascular disease remains a significant contributor to maternal mortality in Illinois.
- A substantial proportion of these deaths are preventable, emphasizing the need for improved healthcare provider awareness and patient education.
- Intensified postpartum monitoring and addressing identified patient and provider factors are critical for reducing cardiovascular maternal mortality.
Objective:
To describe the demographic characteristics of women in Illinois who died from cardiovascular disease during pregnancy or up until 1 year postpartum, addressing specific etiologies, timing of death, proportion of potentially preventable mortality, and factors associated with preventability.
Methods:
This is a retrospective analysis from the Illinois Department of Public Health Maternal Mortality Review process using International Classification of Diseases, 9th Revision codes that attributed cardiovascular disease as the immediate or underlying cause of maternal death in Illinois from 2002 to 2011. We categorized the etiology of cardiovascular mortality, analyzed demographic factors associated with cardiovascular mortality in comparison with noncardiovascular causes, defined the relationship to pregnancy, and identified factors associated with preventability.
Results:
There were 636 deaths in Illinois from 2002 to 2011 of pregnant women or within 1 year postpartum. One hundred forty women (22.2%) died of cardiovascular causes, for a cardiovascular mortality rate of 8.2 (95% confidence interval 6.9-9.6) per 100,000 live births. Women with cardiovascular mortality were likely to be older and die postpartum. The most common etiologies were related to acquired cardiovascular disease (97.1%) as compared with congenital heart disease (2.9%). Cardiomyopathy was the most common etiology (n=39 [27.9%]), followed by stroke (n=32 [22.9%]), hypertensive disorders (n=18 [12.9%]), arrhythmias (n=15 [10.7%]), and coronary disease (n=13 [9.3%]). Nearly 75% of cardiac deaths were related to pregnancy as compared with 35.3% of noncardiac deaths. More than one fourth of cardiac deaths (28.1%) were potentially preventable, attributable primarily to health care provider and patient factors.
Conclusion:
From 2002 to 2011, more than one fifth of maternal deaths in Illinois were attributed to cardiovascular disease such as cardiomyopathy. More than one fourth of these deaths were potentially preventable. Health care provider and patient factors were identified, which may be modifiable through education and intensive postpartum monitoring, which may diminish mortality. State maternal mortality reviews can identify opportunities for reducing maternal deaths.