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Pregnancy-Related Mortality Due to Cardiovascular Conditions: Maternal Mortality Review Committees in 32 U.S. States,
Joan Briller1, Susanna L Trost2, Ashley Busacker2
1Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA.
Insights
Most pregnancy-related deaths from cardiovascular conditions (CVs), including cardiomyopathy (CM), are preventable. Maternal Mortality Review Committees identified key factors and recommend improved awareness and care coordination to reduce these tragic deaths.
Area of Science:
- Cardiovascular Health
- Maternal Health
- Public Health Surveillance
Background:
- Cardiomyopathy (CM) and other cardiovascular conditions (OCVs) are leading causes of pregnancy-related mortality in the U.S.
- Understanding the characteristics and preventability of these deaths is crucial for improving maternal outcomes.
Purpose of the Study:
- To analyze demographic and clinical factors of pregnancy-related deaths due to CM, OCVs, and combined cardiovascular conditions (CVs).
- To identify contributing factors and review Maternal Mortality Review Committee (MMRC) recommendations for prevention.
Main Methods:
- Analysis of pregnancy-related death data from MMRCs in 32 states (2017-2019).
- Focus on deaths with underlying causes of CVs, including CM and OCVs.
- Description of demographic distributions, frequent contributing factors, and MMRC prevention recommendations.
Main Results:
- 210 pregnancy-related deaths attributed to CVs (40% CM, 60% OCVs).
- Over 75% of these deaths were deemed preventable by MMRCs.
- Key contributing factors and multilevel prevention recommendations were identified.
Conclusions:
- The majority of pregnancy-related deaths from CM and OCVs are preventable.
- MMRC recommendations highlight opportunities for prevention through increased awareness of warning signs, enhanced care coordination, and improved access to integrated services.
Background:
Cardiomyopathy (CM) and other cardiovascular conditions (OCVs) are among the most frequent causes of pregnancy-related death in the United States.
Objectives:
The purpose of this paper was to report demographic and clinical characteristics, preventability, contributing factors, and Maternal Mortality Review Committee (MMRC) recommendations among pregnancy-related deaths with underlying causes of CM, OCVs, and the 2 combined (cardiovascular conditions, CV).
Methods:
We analyzed pregnancy-related death data from MMRCs in 32 states, occurring during 2017 to 2019, with MMRC-determined underlying causes of CVs. We describe distributions of demographic characteristics, present the most frequent contributing factor classes, and provide example MMRC prevention recommendations.
Results:
Among 210 pregnancy-related deaths due to CVs, 84 (40%) were due to CM and 126 (60%) to OCVs. More than half (51.2%) of CM deaths were among non-Hispanic Black persons. Two-thirds (66%) of all CV deaths occurred among people <35 years old. Approximately 53% of CM deaths and 31% of OCV deaths occurred 43 to 365 days postpartum. Over 75% of pregnancy-related deaths due to CVs were determined by MMRCs to be preventable. The 5 most frequent contributing factor classes accounted for 50% of the total MMRC-identified contributing factors. MMRC prevention recommendations occur at multiple levels.
Conclusions:
Most pregnancy-related deaths due to CM and OCV are preventable. Example MMRC recommendations provided in this report illustrate prevention opportunities that address contributing factors, including broader awareness of urgent warning signs, improved handoffs for care coordination and continuity, and expanded accessibility of community-based comprehensive and integrated care services.
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