Postpartum Maternal mortality following live birth in Israel 1998-2017: Trends and causes

To describe temporal trends and causes of postpartum maternal mortality following livebirth in Israel during 1998-2017, including deaths up to one year postpartum.

National retrospective population-based study using de-identified Israeli Central Bureau of Statistics mortality records linked to 3,076,207 livebirths (1998-2017). Postpartum livebirth maternal mortality ratios (postpartum livebirth MMR) were calculated for early (0-42 days) and late (43-365 days) postpartum periods. Trend analyses used to roll five-year averages, Mann-Kendall trend test, and generalized Binomial models.

A total of 449 women died within one year following live birth (132 early, 317 late). The overall rolling maternal mortality rate up to 1 year after livebirth declined significantly from 19.6 to 10.4 per 100,000 live births (rate-ratio 0.53; 95% CI 0.41-0.69). The MMR up to 42 days following livebirth declined significantly from 5.3 to 2.6 per 100,000 live births (rate-ratio 0.48; 95% CI 0.29-0.81). Maternal age >35 years increased mortality risk (OR 2.02; 95% CI 1.39-2.93 early). Direct obstetric causes accounted for 13.6% of deaths; non-obstetric (45.6%) and coincidental causes (27.0%) predominated and unspecified (13.8%). Trend analyses of non-obstetric cause-specific showed significant decline in cardiovascular mortality from 1.81 to 0.69 per 100,000 livebirth between 1998 and 2017, whereas cancer-related mortality exhibited no reduction over the same period.

This national Israeli study, applying the cause of maternal deaths per ICD-MM criteria, shows a 50% decline in maternal mortality following livebirth. Improvements in cardiovascular care likely contributed to the reduction observed in non-obstetric postpartum deaths. Future research should enable access to more detailed information on deaths during pregnancy, abortion, as well as early and late maternal mortality to better target prevention efforts for sub-groups at increased risk.