Perinatal Indicator: Maternal Mortality

Definition

The death of a woman while pregnant, or within one year of pregnancy. The World Health Organization includes in its statistics deaths related to, or aggravated by, the pregnancy or its management, but not accidental deaths. The leading causes of pregnancy-related maternal mortality are embolism, hemorrhage, preeclampsia or eclampsia, infection, and cardiac disease.

Why Does This Matter?

Maternal mortality is a sentinel event in assessing the quality of the healthcare system as a whole. In California, maternal deaths tripled between 1996 and 2006, from 5.6 per 100,000 live births, to 16.9 per 100,000. This is four times higher than the national Healthy People 2010 goal of 4.3 per 100,000. No one can pinpoint with certainty the reasons for this rapid and troubling rise. California’s rates ranged from 5.6 to 10.7 deaths per 100,000 live births, which is consistent with the overall U.S. rate. But by 2006, the California rate had surged to approximately 17 deaths per 100,000 live births. Although the definition of maternal mortality was expanded in 1998 to include all maternal deaths up to one year following birth, this does not account for the persistent rise in maternal mortality rates.

Disparities

For the last 50 years, African American women in the U.S. have experienced a three-to-four times higher mortality rate as a result of pregnancy and birth complications than white women. This rate appears to be independent of age, education, or the number of children they have had. In 2006, African American women in California were more than three times as likely to die from pregnancy-related causes as white women. Factors linked to an increased risk for maternal mortality include being 35 or older, less educated, obesity, and lacking adequate prenatal care. Among women whose pregnancies resulted in a live birth, the risk of pregnancy-related death increased after 20 weeks of pregnancy, and with the birth of a fifth child. The risk is also higher in both the first 12 weeks of pregnancy and after the 23rd week. A recent report showed that cesarean delivery was 10 times more likely than vaginal delivery to result in the death of the mother. Eighty-five percent of maternal deaths were unrelated to any preexisting medical condition, meaning that the vast majority of these pregnancies were originally considered low-risk.

  • Maternal mortality  has been on the rise since 2000 in Los Angeles County, California, and the United States as a whole.
  • The highest rates of death related to pregnancy, childbirth, and puerperium (the time immediately following childbirth, lasting about 6 weeks) were in 2006, with 18.9 deaths per 100,000 live births in California, and 18.4 deaths per 100,000 live births in Los Angeles County.
  • In California, the lowest rates occurred in 2000, with 4 deaths per 100,000. That same year, however, the mortality rates for LA County were much higher, at 12.1 deaths per 100,000 live births.
  • Between 1997 and 2007, there were only two years—1998 and 1999—when maternal mortality rates  in LA County fell below 10 per 100,000 live births.
  • Women in the US have a higher risk of dying of  pregnancy-related complications that those in 20 other developed countries.

For further information, please read the LA Best Babies Network Perinatal Scorecard

matmort

Year
Los Angeles County
California
Deaths
Rate per 100,000 live births
95% Confidence Interval
Deaths
Rate per 100,000 live births
95% Confidence Interval
1997
20
12.3
11.8-12.9
45
8.6
8.3-8.8
1998
14
8.8
8.4-9.3
34
6.5
6.3-6.7
1999
14
9.0
8.5-9.4
43
8.3
8.1-8.5
2000
19
12.1
11.5-12.6
21
4.0
3.8-4.1
2001
20
13.0
12.5-13.6
54
10.2
10.0-10.5
2002
25
16.5
15.9-17.2
56
10.6
10.3-10.9
2003
21
13.8
13.2-14.4
82
15.2
14.8-15.5
2004
26
17.2
16.5-17.8
74
13.6
13.3-13.9
2005
22
14.6
14.0-15.2
92
16.8
16.4-17.1
2006
28
18.4
17.8-19.1
108
18.9
18.9-19.6
2007
22
14.5
13.9-15.1
80
13.8
13.8-14.

Sources: Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs, Perinatal Health Indicators Los Angeles County Report (2007). California Department of Health Services, Center for Health Statistics, Vital Statistics, 2007. US rates extracted from the California Department of Public Health Birth Master Files 1991-2006. Two different types of ICD-9 death classification was used prior to 1998 to calculate death rates, and ICD-10 codes were used post 1998.

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Pregnancy, Childbirth, and Puerperium Deaths by Race/Ethnicity, LA County (2007)

Race/Ethnicity
Number of Deaths
Rate per 100,000 population
Population
Hispanic
11
0.5
2,393,468
White
1
0.1
1,500,823
African American
7
1.5
477,832
American Indian
1
6.4
15,534
Asian
2
0.3
706,218
Pacific Islander
0
0
14,370
Two or More Races
0
0
90,380
LA County
 
5,198,625
  • In Los Angeles County, in 2007, 11 Hispanic women and 7 African American women died during pregnancy, childbirth, or puerperium.
  • Hispanic women make up 46% of all women in LA County, but 50% of all maternal deaths.
  • African American women make up 9.2% of all women in LA County, but 31.8% of all maternal deaths.
  • White  women make up 28.9% of women in LA County, but only 4.5% of maternal deaths.

Source: California Department of Health Services, Center for Health Statistics, Vital Statistics, 2007

Resources:California Pregnancy-Associated Mortality Review (CA-PAMR) 2011