4305.1: Tuesday, October 23, 2001 - Board 3

Abstract #27033

Pregnancy-related mortality due to pulmonary embolism: United States, 1991-1997

Suzanne Zane, DVM1, Jeani Chang, MPH2, Cynthia Berg, MD1, and Carla Syverson, CNM2. (1) Division of Reproductive Health, Maternal Health Team, Centers for Disease Control and Prevention, 4770 Buford Hwy., N.E., Mailstop K-23, Atlanta, GA 30341, (530)345-7076, saz3@cdc.gov, (2) Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA

Pulmonary embolisms are an important component of pregnancy-related mortality in developed nations. We analyzed national trends in pregnancy-related mortality associated with complications of amniotic fluid embolisms (AFE) and pulmonary thromboembolisms (PTE). We examined 1991-1997 deaths in the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System. A pregnancy-related death was defined as the death of a woman during or within one year of pregnancy caused by pregnancy, its treatment, or its complications. The pregnancy-related mortality ratio (PMR) for embolism was defined as the number of pregnancy-related deaths from AFE and PTE per 100,000 live births. AFE or PTE caused 618 of 3203 pregnancy-related deaths (cause-specific PMR=2.2). The ratio of AFE to PTE was 1.3. Mortality from AFE and PTE increased with increasing maternal age; women aged >35 had a fourfold higher PMR than women aged 14-19 (5.4 vs. 1.3). Black women had a PMR 3.5 times higher than that of white women; this disparity is greater than that found during 1970-1985. Median gestational age at time of death was 39 weeks, and 41% of the deaths occurred at or within 24 hours of delivery. Autopsy was performed in 81% of cases. Pulmonary embolism is the leading cause of pregnancy-related death in the United States. The continuing excess risk of pregnancy-related death among black and older women for AFE and PTE emphasizes the need to identify differences which contribute to excess mortality. Investigation of factors that contribute to these disparities is crucial in developing effective strategies for reducing maternal mortality.

Learning Objectives:

  1. Understand the clinical severity of pulmonary embolism in pregnancy.
  2. Describe the epidemiology of pregnancy-related death due to pulmonary embolism and its impact on overall pregnancy-related mortality.
  3. Discuss differences in the pregnancy-related mortality ratios by age and race and discuss how this information can be used in strategies for reducing maternal mortality.

Keywords: MCH Epidemiology, Pregnancy

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 129th Annual Meeting of APHA