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Chronic Diseases and Other Factors Associated With Rising Maternal Mortality in the US

Laura Joszt
Chronic diseases, insufficient access to care, and social determinants of health are targets that can help reduce maternal mortality.
Maternal mortality is a growing concern in the United States, with rates that are moving in the opposite direction of those in peer nations. From 2000 to 2014, the maternal mortality ratio in the United States increased from 9.8 deaths to 21.5 per 100,000 live births.

Chronic diseases, insufficient access to care, and social determinants of health are targets that can help reduce maternal mortality, according to a study of state-level maternal mortality rates and the association with potential risk factors associated with maternal mortality.
The research, which used state-level maternal mortality data from 1997 to 2012, using the National Vital Statistics System compressed mortality files, was published in BMC Public Health. Individual-level factors, such as the number of births to women of advanced age and the increased prevalence of chronic health conditions, can partly explain why the United States is seeing worsening maternal outcomes.

“Population-wide increases in maternal mortality are difficult to attribute solely to trends in individual-level factors, however,” the authors wrote. “Instead, understanding how population-level factors change and relate to maternal mortality over time may provide insights into potentially effective public health and health policy responses.”

It is important to note that nearly one-third (31%) of the increase in maternal deaths could be attributed the adoption of a revised death certificate in 2003 that included a checkbox with questions about the pregnancy status of a female decedent. However, another 31% of the maternal mortality increase is attributable to the proportion of obese women of childbearing age, followed by births to women with diabetes (17%).

Other factors significantly associated with maternal mortality in initial analyses were chronic hypertension, cesarean section rates, and self-reported health status of “fair” or “poor.”

“Taken together, our findings about the importance of mothers’ chronic conditions suggest additional emphasis is warranted to promote the general pre-conception health of women of childbearing age,” the authors wrote.

However, social determinants of health also played a role in mortality. The researchers found a relationship between the maternal mortality rate and the proportion of births to African American women. Initial analyses also found a correlation between mortality and the proportion of births to women of Hispanic ethnicity, as well as uninsurance rates.

The authors noted that the research contains “many of the most salient factors” associated with an increased risk for adverse maternal outcomes, but that it does not include the full range of possible causes of maternal mortality.

The authors concluded that “…health problems such as obesity and diabetes, insufficient healthcare during pregnancy, and social determinants represent identifiable risks for maternal mortality that merit direct and prompt attention in population-directed public health interventions and health policies.”


Nelson DB, Moniz MH, Davis MM. Population-level factors associated with maternal mortality in the United States, 1997-2012. BMC Public Health. 2018;18:1007. doi: 10.1186/s12889-018-5935-2.

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