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American Academy of Pediatrics
Article

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

Ai-ris Y. Collier and Rose L. Molina
NeoReviews October 2019, 20 (10) e561-e574; DOI: https://doi.org/10.1542/neo.20-10-e561
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Ai-ris Y. Collier
*Division of Maternal Fetal Medicine, and
‡Harvard Medical School, Boston, MA
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Rose L. Molina
†Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
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  • Abbreviations:
    ACOG:
    American College of Obstetricians and Gynecologists
    AIM:
    Alliance for Innovation on Maternal Health
    CARE Act:
    Maternal Care Access and Reducing Emergencies Act
    CDC:
    Centers for Disease Control and Prevention
    CMQCC:
    California Maternal Quality Care Collaborative
    ICD-10:
    International Classification of Diseases, 10th Revision
    MMR:
    maternal mortality ratio
    MMRC:
    maternal mortality review committee
    MMRIA:
    Maternal Mortality Review Information Application
    MOMMA Act:
    Mothers and Offspring Mortality and Morbidity Awareness Act
    MOMS Act:
    Maternal and Obstetric Modernization of Services Act
    NCHS:
    National Center for Health Statistics
    PMSS:
    Pregnancy Mortality Surveillance System
    PQC:
    perinatal quality collaborative
    SMM:
    severe maternal morbidity
    WHO:
    World Health Organization
  • Abstract

    The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.

    • Copyright © 2019 by the American Academy of Pediatrics

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    Vol. 20, Issue 10
    1 Oct 2019
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    Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions
    Ai-ris Y. Collier, Rose L. Molina
    NeoReviews Oct 2019, 20 (10) e561-e574; DOI: 10.1542/neo.20-10-e561

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    Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions
    Ai-ris Y. Collier, Rose L. Molina
    NeoReviews Oct 2019, 20 (10) e561-e574; DOI: 10.1542/neo.20-10-e561
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    • Article
      • Abstract
      • Practice Gaps
      • Objectives
      • Introduction
      • Definitions and Data Collection Challenges
      • Causes of Maternal Mortality and Morbidity
      • Inequities in Maternal Morbidity and Mortality
      • Improving Safety and Quality of Childbirth Care
      • Current Health Care Policy to Address Maternal Mortality
      • Prepregnancy and Interpregnancy Health
      • Conclusion
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • Comments
    • Quiz

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