- A new study challenges current CDC reporting on rising maternal mortality rates in the United States, suggesting that maternal mortality rates are stable and comparable to other developed countries.
- The study authors argue that a “pregnancy checkbox” introduced by the CDC in 2003 may have contributed to inaccuracies in the number of pregnancy-related deaths.
- Researchers say discrepancies regarding direct, indirect, accidental and accidental deaths of pregnant people may have led to reporting errors.
- The CDC disagrees with the study’s findings and stands by the accuracy of the data collection methods.
The ongoing maternal and child health crisis in the United States is affecting millions of women without access to quality prenatal and postnatal care, especially those living in areas with limited access to abortion.
These disparities have a disproportionate impact, accelerating the rise in maternal mortality.
However, new research suggests that the number of maternal deaths over the past 20 years may have been overestimated.
The study was published in the journal March 12th. Journal of the American College of Obstetricians and Gynecologistsshows that the U.S. maternal mortality rate is stable and comparable to other developed countries.
Research data also shows that maternal deaths from direct obstetric causes have decreased over the past two decades.
Researchers argue that the introduction of a pregnancy checkbox on death certificates in 2003 to indicate whether someone was pregnant at or just before death misrepresented an increase in maternal deaths. ing.
“Our research showed that maternal mortality rates remained low and stable between 1999-2002 and 2018-2021. This is very different from a significant increase.”
“We found that relying solely on pregnancy checkboxes on death certificates, without corroboration with cause of death information, led to overestimation of maternal mortality rates by the NVSS from 2018 to 2021.”
Researchers found that maternal deaths in the United States remained generally stable, averaging just over 10 deaths per 100,000 live births from 1999 to 2002 and from 2018 to 2021.
This is inconsistent with the maternal mortality rate reported by the Centers for Disease Control and Prevention, which increased from 9.65 deaths per 100,000 live births to 23.6 deaths per 100,000 live births over the same period.
These findings call into question the increasing trends previously reported by the National Vital Statistics System (NVSS), a division of the CDC.
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The CDC told Healthline that the agency disagrees with AJOG’s analysis.
“The methodology used in the AJOG report is known to significantly underestimate maternal mortality, which would not have been identified if the death certificate did not include a pregnancy checkbox. and maternal deaths,” a CDC spokesperson said.
“Understanding these unrecorded maternal deaths is critical to understanding the scope of maternal deaths in the United States and to implementing effective public health measures to prevent these deaths. The report’s analysis makes no mention of this, nor does it provide any evidence of how large the potential overcount might be.
Maternal death can occur during pregnancy, childbirth, or the puerperium due to conditions directly related to pregnancy or exacerbated by pregnancy and childbirth.
To find out whether current maternal mortality rates are accurate, researchers looked at NCHS data from 1999 to 2021.
They investigated factors that may be causing the increase. These include:
- Changes in obstetric factors
- maternal chronic illness
- “Monitoring issues” (e.g. changes in data collection methods)
They also focused on maternal deaths, including pregnancy among the causes of death on death certificates.
The researchers concluded that deaths attributable to obstetric causes (i.e., preeclampsia and hemorrhage) decreased over the period they studied.
However, deaths attributable to indirect causes (such as high blood pressure) exacerbated by pregnancy increased.
Similar to the CDC report, non-Hispanic black women had disproportionately higher rates of maternal mortality due to complications such as:
- ectopic pregnancy
- cardiovascular condition
- kidney disease
- other diseases
Researchers determined that checking the pregnancy box was associated with higher rates of less specific accidental causes of death.
“By not relying on pregnancy checkboxes, we were able to avoid misclassification that could give the false impression that maternal mortality rates are rising in the United States,” said study co-author Dr. Johnson. Justin S. Brandtsaid in a release, head of the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, New York University Grossman School of Medicine.
“When we identify maternal deaths by requiring mention of pregnancy among multiple causes of death, we find that maternal mortality rates are stable and maternal deaths due to direct obstetric causes are decreasing.”
In 2003, the NCHS recommended adding a “pregnancy checkbox” to U.S. death certificates to better account for deaths due to pregnancy complications.
As states began implementing the checkbox from 2003 to 2017, the CDC found that data quality improved and maternal mortality rates more than doubled than previously reported rates.
In 2018, NCHS
However, the pregnancy checkbox may have led to inconsistencies regarding how positive checkboxes were interpreted and explained.
For example, a pregnant person who dies due to high blood pressure will have a positive checkbox on the death certificate. However, this is not considered death of the mother, even though the pregnancy may have worsened the mother’s condition.
Another example is a pregnant person with cancer who temporarily stops chemotherapy during pregnancy, but then dies from the cancer because she is unable to receive treatment. This person will see a positive result in the pregnancy checkbox even though the cause of death was cancer rather than obstetrics.
“Researchers involved in the new study believe that the pregnancy checkbox system still accounts for many non-maternal deaths and accidental deaths (i.e. traffic accidents) as maternal deaths, which may contribute to errors in CDC maternal mortality reporting. It is argued that this is a contributing factor.” the CDC told Healthline.
“That said, AJOG’s report corroborates previous CDC analysis that found pregnancy boxes on death certificates are sometimes incorrectly checked, which may be contributing to some overcounts. It has become.”
Despite disagreements about how maternal deaths are reported, experts say unacceptable disparities in maternal health care continue to exist, with disproportionate numbers of deaths occurring among racial and ethnic minority groups. They agree that it causes 100% of maternal deaths.
Looking ahead, the study’s researchers say the check-box system could be improved by requiring doctors to identify pregnancy-related causes of death.
“Accurately assessing the number and causes of maternal deaths is a key priority for countries and health policy makers. Improving maternal mortality monitoring is key to developing plans to improve maternal health. ” said Editor-in-Chief Dr. Roberto Romero. American College of Obstetricians and Gynecologists (AJOG) Obstetricssaid NIH’s NICHD Pregnancy Research Division Director. statement.
Anu Sharma, Founder and CEO millietold Healthline that mortality rates generally give a narrow picture of the maternal health crisis in the United States.
“Whether or not this particular data is a miscalculation, there is no doubt that maternal morbidity is high, with nearly 50,000 near misses occurring annually, resulting in higher rates of caesarean sections, preterm births, NICU stays, and poor maternal mental health. There is also a high rate of deterioration.It is healthy,” Sharma said.
“Additionally, as this study continues to confirm, racial disparities in Black births are significant. 36% Of all the counties in the United States, it is designated as a maternity care desert. As researchers, policy makers, and health care providers all know, blaming the U.S. maternal health crisis on methodological differences in how mortality rates are calculated is a challenge faced by mothers giving birth in the United States today. It will ignore the harsh reality that exists. ”
A new study suggests that the U.S. maternal mortality rate may be lower than previous CDC estimates because of the addition of a pregnancy checkbox on death certificates in 2003.
CDC disagrees with the way the study authors calculated maternal mortality rates and stands by the accuracy of CDC’s reporting of the data.
Whether maternal deaths are increasing, decreasing, or stable, the United States continues to have a maternal health crisis to contend with.
