Study: Maternal mortality may be overestimated, but still too many deaths

Obvious rapid increase in maternal mortality rate The United States has been on heightened alert in recent years.according to Data from the Centers for Disease Control and Prevention According to the (CDC), the country's maternal mortality rate increased by about 40% in 2021 compared to the previous year. This sharp increase resulted in 32.9 deaths per 100,000 live births, compared to 23.8 deaths per 100,000 live births in 2020.

vox And many publications have reported on this increase, which is a cause for serious concern. But this week, a new peer-reviewed study found that Journal of the American College of Obstetricians and Gynecologists While suggesting that the maternal mortality rate in the United States; Still high for a developed country And troublingly, that number is lower than what the CDC data showed.

In the study, external researchers led by KS Joseph, a physician and professor at the University of British Columbia, used a different methodology than the CDC to calculate maternal mortality rates, and estimated that the It was concluded that the number of deaths was 10.4.not a higher number The agency also set the same period.. They say that because of U.S. data collection methods, the CDC overestimates the number of deaths due to both clerical errors and deaths that were not directly caused or exacerbated by pregnancy (including, for example, pregnant women who died of cancer). It is claimed that it is counted as . .

They also reaffirmed another alarming reality: Researchers continued to find clear racial disparities using this new calculation method, including black women being three times more likely to suffer fatal complications compared to white women .

One thing worth noting is that the study authors acknowledge that their methodology may result in: by undercount. “My opinion is that the true maternal mortality rate is probably somewhere between what these authors propose and the actual maternal mortality rate. [CDC’s] The National Center for Health Statistics states: Alison Gemmilla professor at the Johns Hopkins School of Public Health who specializes in maternal health and was not involved in the study told Vox. “CDC disagrees with the findings,” the agency also said. Statement to NPRadded that the approach the researchers used “is known to significantly underestimate maternal mortality.”

Gemmill says data on this issue is difficult to identify, both because of documentation issues and the need to track medical complications at different stages of pregnancy. For example, if a death occurs during early pregnancy or after childbirth, the number of deaths may not be counted accurately and may not be attributed to the pregnancy.

Experts say having reliable data on maternal mortality is critical to better understand causes, treatments and early intervention. Although this study provides evidence that the scope of the problem may not be that large, it remains an urgent problem. “Every maternal death is too many. And we know these deaths are preventable,” Gemmill says.

What does research involve?

The results of the Joseph-led study differed greatly because of differences in the way these researchers calculated maternal deaths and the way the CDC calculated them. According to the CDC, maternal deaths It is defined as “the death of a woman during pregnancy or within 42 days after termination of pregnancy,” excluding cases due to accidental or fortuitous causes.

Both the CDC study and Joseph's study obtained data from death certificates filled out for people who died in the United States. That certificate has a checkbox to indicate whether the person was pregnant at the time of death or 42 days prior. This checkbox was added in 2003 to better track which deaths were related to pregnancy in some way. Since then, the number of deaths classified as maternal deaths has skyrocketed in the United States.

In its data, the CDC used its “pregnancy checkbox” to identify who was pregnant, and counted those checked as maternal deaths if they were of childbearing age. However, the problem with using this information is that this checkbox may be accidentally unchecked. Discovered by Texas researchers in 2018. For example, in that study, multiple non-pregnant people checked this box.

In addition, there are cases in which pregnant women die from other diseases such as cancer. Under the CDC approach, these deaths are also considered maternal deaths, even if pregnancy did not directly cause or worsen these deaths. Joseph believes these cases inflate the number of deaths classified as maternal deaths.

To make calculations that try to account for both issues, Joseph and his team counted only deaths where the death certificate listed pregnancy as the clear cause of death. Using that information, they arrived at a much lower number, but reveal that this data may be flawed by being an underestimate.

“Weaknesses of this study include its reliance on cause of death data from death certificates, which may lead to an underestimation of maternal mortality,” the researchers wrote in their paper. . “This reflects a very limited and limited method of calculating these numbers, whereas the CDC's method is the most comprehensive.” louise kingA professor at Harvard Medical School and a physician at Brigham and Women's Hospital also warned.

Joseph's study and its weaknesses highlight the difficulty and importance of collecting reliable data on this topic. Maternal mortality data collection is unreliable in the United States. Death certificates contain errors because they do not fully capture the symptoms a person may have experienced. mental health Symptoms such as postpartum depression.

There is also debate over which deaths should be considered maternal deaths. For example, some deaths are caused by other factors and conditions that may still be associated with pregnancy.

“Opioid overdose occurs in pregnant people. I had to quit cold turkey. Recurrence during pregnancy and thereafter. Suicide may be caused by postpartum depression.Murder may occur as a result of a fight with a person Domestic partners About Pregnancy” Annalisa Merelli Contribute to Stat News.

Gemmill said the UK is considered the gold standard in how it approaches the issue because it uses multiple sources to investigate maternal deaths, not just death certificates. In addition to the information provided by death certificates, British authorities also use birth certificates to confirm that a person was pregnant. conduct what is known as a “confidential investigation”; With respect to certain medical records of individuals.

In the United States, some state-level commissions also look into individual maternal deaths more deeply, but they do so inconsistently and politicized, Meleri wrote.

What do we think about the maternal mortality rate in the United States now?

Even if the rate is lower than previously reported exorbitant rates, it is still alarming that women are dying as a result of pregnancy and its associated complications.

“Moms are getting older and more likely to have high blood pressure, diabetes, and chronic conditions than they did 20 years ago, which puts them at higher risk,” Joseph told Box. Ta. “So if we don't continue to focus on addressing maternal mortality, the situation will get even worse. And we need to bring it down from the status quo.”

Based on data from Commonwealth Fund 2022 analysis, Even with more conservative estimates, the maternal mortality rate in the United States remains higher than in many other developed countries. One caveat Joseph points out is that it's difficult to compare across countries because each country has its own measurement system.

If U.S. interest rates were closer to Mr. Joseph's results, the country would be more in line with many other developed countries, but still slightly ahead. According to analysis by the Commonwealth Fund, 10 countries have a death rate of less than 10 deaths per 100,000 live births, with the Netherlands, Australia and Japan all leading the way with less than 3 deaths per 100,000 live births.

Concerns persist about racial disparities and the disproportionate number of black women dying during and after pregnancy. systemic racismincluding discriminatory treatment within the hospital; If your doctor ignores or downplays your symptoms We know that the central factor is that women are raising children.unequal access health care Treatment of chronic diseases before pregnancy also plays a role. Researchers found a high mortality rate from ectopic pregnancies. high blood pressureJoseph reports on her research on cardiovascular disease in black women.

The goal of obtaining better data about this problem and the symptoms that cause it is to allow doctors to better identify treatments and preventive measures that can help patients, Joseph said. say. This study is ultimately part of that conversation.