Context Deaths occurring among women who are pregnant or who have had a recent
pregnancy have a devastating impact on the family and community. It is important
to understand the magnitude and causes of pregnancy-associated mortality so
that comprehensive strategies can be formulated to prevent such deaths.
Objective To ascertain the number and causes of pregnancy-associated deaths using
enhanced surveillance techniques.
Design, Setting, and Subjects Retrospective, cross-sectional analysis of death certificate data of
reproductive-age women, live birth and fetal death records, and medical examiner
records in Maryland during 1993-1998.
Main Outcome Measure Number of pregnancy-associated deaths, defined as death from any cause
during pregnancy or within 1 year of delivery or pregnancy termination, by
source of data and cause of death.
Results A total of 247 pregnancy-associated deaths were ascertained. Twenty-seven
percent (n = 67) were identified through cause-of-death information obtained
from death certificates, 70% (n = 174) through linkage of death records with
birth and fetal death records, and 47% (n = 116) through review of medical
examiner records. Homicide was the leading cause of pregnancy-associated death
(n = 50; 20%), and cardiovascular disorders were the second-leading cause
(n = 48; 19%).
Conclusions In this Maryland sample, comprehensive identification of pregnancy-associated
deaths was accomplished only after collecting information from multiple sources
and including all deaths occurring up to 1 year after delivery or pregnacy
termination. This enhanced pregnancy mortality surveillance led to the disturbing
finding that a pregnant or recently pregnant woman is more likely to be a
victim of homicide than to die of any other cause. By broadening pregnancy
mortality to include all possible causes, previously neglected factors may
assume increased importance in prenatal and postpartum care.