The United States is one of just eight countries to see a rise in maternal mortality over the past decade, said researchers for the Institute for Health Metrics and Evaluation at the University of Washington in a study published in The Lancet, a weekly medical journal. The others are Afghanistan, Greece, and several countries in Africa and Central America.
The researchers estimated that 18.5 mothers died for every 100,000 births in the U.S. in 2013, a total of almost 800 deaths. That is more than double the maternal mortality rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.
The study was the latest to underscore a steep rise in pregnancy-related deaths in the U.S. since at least 1987, when the mortality rate was 7.2 per 100,000 births. The U.S. experienced a sharp spike in 2009 that the Centers for Disease Control attributed to the H1N1 influenza pandemic. The rate has dipped slightly since then, said Nicholas Kassenbaum, the lead physician in the University of Washington study, but it remains stubbornly high.
The increase is in stark contrast to most other countries that have had notable decreases, including many in east Asia and Latin America, the report said. The United States now ranks 60 for maternal deaths on a list of 180 countries, down markedly from its rank of 22 in 1990. China, by contrast, is up to number 57.
The reasons for the rise in the maternal deaths in the United States are not entirely clear, but several factors seem to be in play.
One reason for the rise is an improvement in how maternal deaths are reported, though Kassebaum said the numbers are still likely underreported and mischaracterized in the codings included on death certificates.
Equally significant is an increase in the number of pregnant women who have diseases that contribute to a higher-risk pregnancy, such as hypertension and diabetes, said Kassebaum. He said there also has been an increase in mothers whose pregnancies are riskier because of conditions like heart or neurological diseases who might have died in an earlier era but who now are surviving into adulthood.
In the world as a whole, fully half the maternal deaths happen more than 24 hours after childbirth — up to a year later. It's a little higher in the United States, 55 percent.
Kassebaum said that is because of improved American techniques for treating conditions that cause maternal deaths during childbirth itself, such as obstructed labor and hemorraging. The Centers for Disease Control lists ardiovascular disease and infections as the conditions with the highest maternity mortality rates, and anesthesia complications as the lowest.
Worldwide, the study estimated that 293,000 women died of pregnancy-related causes in 2013, down from 376,000 in 1990.
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