June 18, 2010 – Giving birth has become vastly safer for women over the past century, but progress has recently stalled in this country. Neither New York City nor the nation has seen a significant drop in maternal deaths since 1990, and the city’s rate remains higher than the nation’s. In an effort to address the problem, the Health Department, beginning in 2002, enhanced its systematic investigation of every maternal death in the city, analyzing medical charts, assessing risk factors and examining hospital procedures. In a report released in concert with the New York Academy of Medicine (NYAM) on Friday, June 18, the Health Department lays out the findings from this enhanced surveillance effort.
The maternal mortality ratio (MMR) is the number of maternal deaths that occur for every 100,000 live births. By that measure, New York City’s average rate was twice as high as the nation’s (23.1 versus 11.8 per 100,000) between 2001 and 2005. The Health Department’s new report – Pregnancy-Associated Mortality: New York City, 2001-2005 – goes beyond that finding to analyze the 161 maternal deaths that were directly related to pregnancy during that period. By carefully reviewing the social and medical histories of the women, and the circumstances of their deaths, the report’s authors gained insights that should help caregivers, researchers and policy makers develop better strategies for prevention.
“Maternal mortality is a leading indicator of women’s health and the health of communities,” said Dr. Thomas Farley, New York City Health Commissioner. “It is far less common than it once was, but it is a devastating experience for any family. By conducting this aggressive surveillance – and working with health care providers, community partners and other government agencies – we can better address underlying risk factors – and ultimately better prepare for obstetric emergencies.”
“Despite the good work being done to reduce maternal mortality, more is needed,” said Dr. Jo Ivey Boufford, President of NYAM. “Leading experts including city and state health officials have issued a call for action – a call for a sustained and integrated approach that coordinates prevention programs, prenatal and primary care, and labor and delivery. New York can continue to set the standard for improving urban health, especially around the critical issue of pregnancy-related mortality.”
The leading causes of maternal mortality are embolism (blood clots), hemorrhage (bleeding), hypertension-related illnesses, and infection. Although the causal relationships are not well established, maternal mortality is also associated with poverty, obesity and underlying chronic illness. The report finds that of all the women who died from pregnancy-related causes, nearly half (49%) were obese and 56% had at least one chronic health condition such as hypertension or asthma. Illustrating significant racial disparities, the report also shows that black women were more than seven times as likely as white women to die from pregnancy-related causes during the study period. The report also documents higher pregnancy-related mortality ratios for women 40 and older (63.0 per 100,000 versus 24.4 among women under 40).
The Health Department’s enhanced surveillance system uses multiple sources to identify deaths of women while pregnant or within one year after the end of pregnancy. This method uses medical charts, autopsy reports, and death and birth certificate information to bothimprove case ascertainment and to offer insight into the medical and social factors that contribute to maternal deaths. By contrast, standard surveillance focuses on a limited subset of deaths (those that occur while a woman is pregnant or within 42 days after the end of pregnancy that are related to or aggravated by the pregnancy or its management) and relies solely upon the death certificate to identify maternal deaths. The enhanced surveillance system provides a more accurate picture of maternal mortality than the standard one, allowing for more targeted prevention planning and intervention.
The Health Department is committed to examining every maternal death and to promoting maternal health. The agency is working to combat maternal mortality through several measures and initiatives. Some examples:
- Health Department researchers comb state and city death records, as well as records from the City medical examiner’s office, to capture as many cases as possible.
- When maternal deaths are identified from death certificates, obstetric experts review autopsy reports and medical records to identify risk factors (such as obesity) and acute causes (such as hemorrhage).
- The Maternal Mortality Review Committee identifies and recommends interventions to prevent maternal death and address racial and socioeconomic disparities. The committee includes representatives from the obstetric community, the medical examiner’s office, the New York State Department of Health, the American Congress of Obstetricians and Gynecologists, and community-based organizations.
- The Health Department conducts lectures and issues alerts to educate obstetric providers and other stakeholders on the causes of adverse pregnancy outcomes and the best ways to prevent them.
- City agencies work on many fronts to prevent obesity, diabetes, hypertension, cardiovascular disease, and other health conditions that raise the risk of pregnancy complications. These efforts include improving access to healthy foods and physical activity.
To read the report, Pregnancy-Associated Mortality: New York City, 2001-2005, visit http://www.nyc.gov/html/doh/downloads/pdf/ms/ms-report-online.pdf.