Maternal mortality in the United States, 1979-1986

Article Abstract:

Although maternal mortality declined dramatically from 1940 to 1980 (from 376 to 9 maternal deaths per 100,000 live births), the death rates for minority women are still more than twice as high as for whites. To understand more about the causes of maternal death, a retrospective study examined all maternal deaths in the US during the years 1979 through 1986. Maternal deaths were those that occurred during pregnancy or within one year afterwards (if related to or aggravated by the pregnancy). Immediate and underlying causes of death were noted and classified. Results showed that 2,644 maternal deaths were reported in the period studied, of which 1,363 occurred after live births; 343 in association with ectopic pregnancies (pregnancies implanted in sites other than the uterus); 263 in association with stillbirths; 124 in association with abortion; and 146 before delivery. The majority of maternal deaths took place during pregnancy or soon after delivery or termination, with fewer occurring at longer intervals after the pregnancy. Overall, the maternal mortality ratio was 9.1 deaths per 100,000 live births, but pronounced differences in rates between minority and white women were seen. Between 1979 and 1986, maternal mortality decreased from 7.1 to 5.1 for white women, and from 27.2 to 16.6 for minority women. Older women had higher death rates than younger women. Unmarried women had an almost threefold-elevated death rate, compared with married women, with marriage reducing the rate more for whites than blacks. The primary causes of death were pulmonary embolism (a clot that lodges in the pulmonary artery), pregnancy-induced hypertension (high blood pressure), hemorrhage, complications of ectopic pregnancy, and infection. A greater proportion of women who died after a live birth had inadequate prenatal care compared with women in the US as a whole (15 versus 5.5 percent). These results indicate that, although decreasing in number, maternal deaths still occur. Their relatively low number has led to the elimination of Maternal Mortality Review Committees in many states, which means no formal mechanism exists for gathering data such as these. Indeed, such a mechanism is needed, if the rate is to be brought even lower. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Ethnic groups, Mortality and race

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Infant mortality among hispanics: a portrait of heterogeneity

Article Abstract:

Little is known concerning infant mortality among Hispanics, for three main reasons: Hispanics in the US are a diverse group, with differing socioeconomic characteristics; Hispanics have diverse political backgrounds (undocumented aliens versus Puerto Ricans, who are US citizens from birth); and definitions of who is Hispanic vary. Accurate analyses should use birth and death records that are linked (known to be from the same person). Twenty-three states and the District of Columbia include the category of Hispanic on birth certificates. The 1983 and 1984 Linked Birth and Infant Death data sets for the continental US, and records for singleton pregnancies delivered in Puerto Rico in those years, were analyzed. Results showed that the neonatal mortality risk (NMR; deaths of infants younger than 28 days old per 1,000 live births) was higher among Puerto Rico islanders and Puerto Ricans who live in the US than among non-Hispanic whites (the group taken as reference). Continental Puerto Ricans also had the highest postneonatal mortality risk (PNMR; risk of death between the ages of 28 and 364 days): the relative risk, or RR, was 1.2, compared with the reference group. Cuban-Americans, on the other hand, had the lowest PNMR (RR = 0.6); the NMR for Cuban-Americans and Mexican-Americans was also lower than for Puerto Ricans. Mexican-Americans had the highest rates of births out of a hospital setting (2.5 percent). The rate of low-birth-weight infants (less than 2,500 grams) was 5.5 percent for Hispanics, 4.7 percent among non-Hispanic whites, and 11.5 percent for non-Hispanic blacks. Additional data concerning survival of infants of different birth weights and ethnicity are presented. The results illustrate that Hispanics in the US are a heterogeneous groups, with disparate health care needs where infant mortality is concerned. The January 9, 1991 issue of The Journal of the American Medical Association is devoted to the health of, and health care for, Hispanics in the US. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Demographic aspects, Infants, Infant mortality

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Pregnancy-associated deaths due to AIDS in the United States

Article Abstract:

Currently 9 percent of all AIDS patients in the U.S. are women; however, in certain areas the percentage may be as high as 20 percent. Projections suggest that soon the percentage of female AIDS victims will reach 10 percent. Since approximately 80 percent of all female AIDS sufferers are of child-bearing age, the public health concern of pregnancies within this group is high. Already AIDS has become the leading cause of death of women between the age of 25 and 34. Controversy remains concerning the effect of pregnancy on the course of the disease. Twenty previously unpublished cases of women who died of AIDS within one year of the termination of a pregnancy were identified by this study. Most of the women were black or Hispanic and approximately one half were intravenous drug users. Most succumbed to a form of pneumonia caused by a microorganism, Pneumocystis carinii. Many of the women had premature delivery and all experienced some form of obstetrical difficulty. Within this group of women, the time between a diagnosis of AIDS and death ranged from 1 day to 15 months; the average time of death was 113 days after diagnosis.

Case studies, Complications and side effects, AIDS (Disease), Pregnancy, Complications of, Pregnancy complications

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