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Pregnancy-related deaths more frequent than reported

A new study highlights why a broader definition of maternal mortality raises public health challenges.

By Stephanie Stapleton, amednews staff. April 9, 2001.

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Washington -- Maternal mortality in the United States is measured in single digits.

However, a study published in the March 21 JAMA offered a new round of evidence that the number of women who die from pregnancy-related illnesses or episodes is chronically undercounted. Even more disturbing, the study's data, collected in Maryland, conclude that the primary cause of these deaths was homicide.

"Clearly, pregnancy is a lot safer than it was 50 years ago, but not as safe as we would expect. Many deaths are not counted," said Isabelle L. Horon, DrPH, director of the Maryland Dept. of Health and Mental Hygiene Vital Statistics Administration in Baltimore, and lead author of the JAMA article.

Uncovering the number of homicides, which accounted for 20% of all pregnancy-related deaths in the study, was not the goal of her research, she added. But it was a surprising finding that raises important public health policy questions. "Until we know what is a problem, we don't know how to address it," she said. "[Identification] is the first step."

When women who are pregnant or who have had a recent pregnancy die, it is devastating to family, friends and communities. The collection of accurate information about these deaths is critical in developing preventive strategies, according to the article. And the first step is gaining a more clear picture of the magnitude of pregnancy-associated mortality so that interventions can be formulated.

In 1993, for instance, there were three maternal deaths reported in Maryland. "You look at that number and think 'three deaths -- big deal,' " said Dr. Horon. However, researchers accumulated data indicating that the number was actually substantially higher and the causes significantly broader. [...]