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. 2024 Nov 8;3(12):101382.
doi: 10.1016/j.jacadv.2024.101382. eCollection 2024 Dec.

Pregnancy-Related Mortality Due to Cardiovascular Conditions: Maternal Mortality Review Committees in 32 U.S. States, 2017 to 2019

Joan Briller  1 , Susanna L Trost  2 , Ashley Busacker  2 , Naima T Joseph  3 , Nicole L Davis  2 , Emily E Petersen  2   4 , David A Goodman  2 , Lisa M Hollier  2
Affiliations

Pregnancy-Related Mortality Due to Cardiovascular Conditions: Maternal Mortality Review Committees in 32 U.S. States, 2017 to 2019

Joan Briller et al. JACC Adv. .

Abstract

Background: Cardiomyopathy (CM) and other cardiovascular conditions (OCVs) are among the most frequent causes of pregnancy-related death in the United States.

Objectives: The purpose of this paper was to report demographic and clinical characteristics, preventability, contributing factors, and Maternal Mortality Review Committee (MMRC) recommendations among pregnancy-related deaths with underlying causes of CM, OCVs, and the 2 combined (cardiovascular conditions, CV).

Methods: We analyzed pregnancy-related death data from MMRCs in 32 states, occurring during 2017 to 2019, with MMRC-determined underlying causes of CVs. We describe distributions of demographic characteristics, present the most frequent contributing factor classes, and provide example MMRC prevention recommendations.

Results: Among 210 pregnancy-related deaths due to CVs, 84 (40%) were due to CM and 126 (60%) to OCVs. More than half (51.2%) of CM deaths were among non-Hispanic Black persons. Two-thirds (66%) of all CV deaths occurred among people <35 years old. Approximately 53% of CM deaths and 31% of OCV deaths occurred 43 to 365 days postpartum. Over 75% of pregnancy-related deaths due to CVs were determined by MMRCs to be preventable. The 5 most frequent contributing factor classes accounted for 50% of the total MMRC-identified contributing factors. MMRC prevention recommendations occur at multiple levels.

Conclusions: Most pregnancy-related deaths due to CM and OCV are preventable. Example MMRC recommendations provided in this report illustrate prevention opportunities that address contributing factors, including broader awareness of urgent warning signs, improved handoffs for care coordination and continuity, and expanded accessibility of community-based comprehensive and integrated care services.

Keywords: cardiomyopathy; care coordination; knowledge; preventability; quality care; recommendations.

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Conflict of interest statement

This project was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention. There is no additional financial support received for the research, authorship, and/or publication of this article. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Timing of Preventable Pregnancy-Related Cardiovascular Deaths Timing of death was missing or unknown for 1 pregnancy-related cardiomyopathy death. The figure shows the percentage of pregnancy-related deaths with an MMRC-identified underlying cause of death of cardiovascular conditions (excluding hypertensive disorders of pregnancy and cerebrovascular accidents) at 5 time periods from pregnancy to 1-year postpartum. The percentages are displayed for total cardiovascular conditions, and then for cardiomyopathy and other cardiovascular conditions individually. Percentages might not sum to 100 because of rounding. MMRC = Maternal Mortality Review Committee.
Central Illustration
Central Illustration
Cardiomyopathy and Other Cardiovascular Conditions Are Among the Most Frequent Causes of Pregnancy-Related Death in the United States We analyzed pregnancy-related death data from MMRCs in 32 states, occurring during 2017 to 2019, with MMRC-determined underlying causes of cardiovascular conditions. Over 75% of pregnancy-related deaths were determined by MMRCs to be preventable. The five most common contributing factor classes were knowledge, clinical skill/quality of care, continuity of care/care coordination, chronic disease, access/financial. Example MMRC recommendations illustrate prevention opportunities that address contributing factors, including broader awareness of urgent warning signs, improved handoffs for care coordination and continuity, and expanded accessibility of community-based comprehensive and integrated care services. Abbreviation as in Figure 1.
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References

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