GRAPEVINE, Texas – While maternal deaths in medical facilities decreased over the last decade, more women died at home from pregnancy-related causes, a researcher said here.
The rate of pregnancy-related deaths in the home nearly doubled from 2003 to 2016, while the rate in hospitals and other medical facilities fell by as much as one-quarter, reported Angela Burgess, MD, of the Baylor College of Medicine.
Increases in pregnancy-related death rates during this period were most dramatic in women age 45 and older, Burgess said . She said these findings suggest an increased burden of coexistent medical diseases.
Still, Burgess said "in terms of maternal mortality, things may be looking up." However, significant reductions to the maternal mortality rate will be contingent on social, cultural, and environmental factors.
While programs to decrease U.S. maternal mortality rates have emerged in recent years, researchers said that there is little understanding of whether they've had any real effect. The current study aimed to analyze maternal mortality trends by place of death, in order to distinguish deaths related to medical care quality from those related to social, cultural, or environmental factors.
Burgess said her group is the first to analyze maternal mortality by location type.
"We believe that by analyzing the pregnancy-related maternal death ratio by age, race, and place of death, this highlights the complexity of this problem," Burgess said.
Haywood Brown, MD, of the Morsani College of Medicine at the University of South Florida, told 51˶ that these findings show the importance of monitoring postpartum women after they leave the hospital.
"Access to follow-up is still an issue," said Brown, who was not involved in the study. The rise in deaths outside of medical facilities suggests a need for patients to attend their postpartum checkups earlier and more frequently after childbirth, he added.
Brown said that early postpartum visits are crucial to monitor blood pressure, screen for postpartum depression, and check on breastfeeding habits. "It's the most important visit a person can have," he said. A number of postpartum deaths are preventable, he added, and improving access to follow up might lessen the deaths that occur outside of hospitals and other medical facilities.
Burgess and colleagues analyzed birth- and death-related data from the CDC. More than 57 million live births occurred during the study period. In addition to identifying place of death, researchers analyzed age at time of death, cause of death, and race/ethnicity.
The overall maternal death rate in the U.S. remained stable during the study period, but deaths that occurred at medical facilities made up a smaller percentage of the overall rate.
Maternal mortality rates in inpatient facilities fell by 20% during the study period, from 53 to 44 per 100,000 live births (P<0.0001). Pregnancy-related deaths in emergency rooms and outpatient facilities declined 24% (P<0.0001).
Burgess said limitations to the analysis included lack of information about home births and time between childbirth and death.
Disclosures
The study authors reported no conflicts of interest.
Primary Source
Society for Maternal-Fetal Medicine
Burgess A, et al "Hospital maternal mortality rates are falling, overall maternal mortality rate still rises: Implications for forward movement" SMFM 2020; Abstract 5.