To a physician, any disease-related death is one too many. But death is a certainty of life, and despite best efforts, deaths from cancer, heart disease and/or Alzheimer’s are more readily understood, albeit painfully accepted.
Not so with death near the time of birth.
To hear that a woman has died during her pregnancy, or shortly after giving birth, is seemingly more stunning to the senses. But physicians and the general public need to take note of a statistic that for years has gone unnoticed: a persistent increase in maternal mortality from pregnancy-related causes.
A “pregnancy-related death” is defined as “death of a woman while pregnant or within one year of pregnancy termination — regardless of the duration or site of the pregnancy — from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.”
Since 1990, the rate of pregnancy-related deaths for women in the United States has essentially doubled, according to the Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System. Between 1987 and 1990, the rate was 9.1 pregnancy-related deaths per 100,000 live births; the rate in 2011 was 17.8 per 100,000.
CDC researcher Andreea Creanga and colleagues published this data in the American College of Obstetricians and Gynecologists’ January 2015 issue of Obstetrics & Gynecology. The data indicates pregnancy-related mortality increased for all American women and all age groups. The greatest threat is to women 40 years of age and older, regardless of race.
The increase of deaths in women of advanced maternal age is not surprising. American women are increasingly delaying childbirth until their later years. Many undergo assisted-reproductive procedures such as IVF. With that, there is a greater potential for pregnant women to already carry chronic conditions such as hypertension, heart disease and diabetes. Add race, social determinants and other demographic factors, and it’s easy to see the kettle is a-brewing.
Additionally, Hispanics with less than 12 years of education, and blacks who get pregnant outside of wedlock, have higher mortality rates. Black women have the highest risk of dying from pregnancy complications. Between 2006 and 2010, the mean pregnancy-related mortality ratio per 100,000 live births was 11.7 in Hispanics; 12.0 in whites, and 38.9 in blacks.
As a black female ob-gyn who has treated patients of all races, I say it is time to change the history of black women’s (and men’s) health. Black health matters must matter to blacks.
Black women have the least successful health care outcomes for most killer diseases such as diabetes, hypertension, obesity and heart disease. Some attribute this to a lack of access to care or having no insurance. Those factors may play a role. For those who lack insurance, utilizing community health services, as well as better allocation of discretionary spending, is advised. But even for black women with access and insurance, less successful health care outcomes persist.
Black women also experience unique psycho-social stressors that, due to cortisol stimulation, affect their physical condition, decreases immunity and increases the risk of serious diagnoses. In the book “Living Well: The Black Woman’s Guide to Health, Sex and Happiness,” there is a “social stress and black women’s health” infographic that demonstrates this psych-social-physical connection and its increased risk of death.
The increase in pregnancy-related deaths for American women is important data for obstetricians. Regardless of specialty, all physicians need to advise women patients — white, black, Hispanic, Asian or other — that there must be a commitment to seek preventative health care and begin prenatal care early to have not only healthy newborns, but healthy mothers to care for them.
Dr. Melody T. McCloud, founder and medical director of Atlanta Women’s Health Care, is an obstetrician-gynecologist affiliated with Emory University Hospital Midtown.
