Study Shows More Pregnancy-Related Deaths

More women are dying from pregnancy-related diseases than previously thought, according to a new federal study that used improved data-collection techniques to examine maternal deaths.

With the new techniques, researchers at the U.S. Centers for Disease Control and Prevention in Atlanta examined records for the years 1987-90 and found that the pregnancy-related mortality ratio increased from 7.2 per 100,000 live births in 1987 to 10 per 100,000 live births in 1990.

Though the risks of pregnancy are still small compared with other causes of death for women, child birth is not a risk-free event.

“Pregnancy is more dangerous than the reported national statistics” would suggest, said Jeffrey King, vice chairman of the department of obstetrics and gynecology at Wright State University School of Medicine in Dayton, Ohio.

“The general population believes that medicine can cure all,” King added. But “there is indeed a finite risk associated with even the simple process of giving birth.

“It’s not said to scare people, but more to make them cognizant of the reality.”

“We still do not have complete … identification” of all maternal deaths brought on by pregnancy, said CDC medical epidemiologist Cynthia J. Berg, a lead investigator of the study. The true “numbers could be higher,” possibly twice as many, she added.

The study’s findings, reported in the August issue of the journal Obstetrics & Gynecology, showed that the increase in pregnancy-related deaths affected women of all ages and races and followed a period when the risk seemed to be declining.

“The reported pregnancy-related mortality ratios for the United States declined from 10.7 in 1979 to 7.1 in 1986, then increased each year from 1987 through 1990,” the study said. The increase appears to be due to the better data-collection techniques, Berg said.

One of those techniques was expanding the post-birth time frame for counting pregnancy-related deaths.

Leading causes of maternal deaths were hemorrhage, embolism and pregnancy-induced high blood pressure. Other causes included infection and cardiomyopathy, a disease of the heart muscle that appears during pregnancy or after childbirth but whose exact cause is unclear.

King said he was not surprised by the findings because he and others in the field had long suspected that official statistics did not reflect reality.

“I’ve been involved in maternal-mortality surveillance for about 10 years, and everyone who knows (the situation) recognizes that the numbers reported are just the tip of the iceberg with regard to (pregnancy-induced) mortality,” said King, who is also chairman of a special committee on maternal mortality for the American College of Obstetrics and Gynecology.

The study also found that the risk of pregnancy-related deaths among blacks, which has long been higher than that among whites, had grown.

“One of the most striking findings of this analysis is the fourfold excess risk in pregnancy-related death among black women,” the federal team wrote.

In 1987, black women were three times more likely to experience pregnancy-related deaths than white women. By 1990, that risk had increased to 4.1 times that of whites.

As a result, the researchers recommended that efforts to reduce maternal deaths include black women “as a high-risk group.”