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U.S. maternal deaths highest of all developed countries Special

By Megan Hamilton     May 7, 2014 in Health
Seattle - Maternal deaths in the United States are rising and researchers estimate that 18.5 women died out of every 100,000 births, a total of 800 in 2013. The death rate is more than double that of Saudi Arabia and Canada, and triple that of the United Kingdom.
The United States is one of only eight countries in which maternal mortality rates went up in the last year, scientists said. A study published in the Lancet and conducted by researchers for the Institute for Health Metrics and Evaluation at the University of Washington concluded that the US shared this distinction with Afghanistan, Greece, and a number of countries in Africa and Central America, according to the Washington Post.
While death rates in other countries have decreased, the US is now ranked at 60, down from its 1990 rank of 22, and in 1987, the mortality rate in the US was 7.2 deaths per 100,000 births. This is in sharp contrast to most other countries, where the global rate has dropped to 209 deaths per 100,000, according to USA Today. Even China has inched its way up to number 57.
During the 2009 H1N1 influenza pandemic the rate jumped sharply, according to the Centers for Disease Control and Prevention, the Post article stated. The number has dipped slightly, said Nick Kassebaum, the lead physician in the University of Washington Study.
So why are the numbers in the United States rising?
Methods for reporting these deaths have improved, Kassebaum told the Post. However, he notes that the numbers are still likely underreported and also mischaracterized in the codings listed on death certificates.
“This analysis statistically adjusts for underreporting and misclassification, which suggests the US is getting better at reporting, but it does not account for the whole rise,” he says. “Furthermore, if even for the sake of argument one were to assume that it is all due to improved reporting and the most recent numbers are more realistic, that would mean that the USA has had a high maternal mortality (by high-income country standards) for decades.”
The study also showed that there have been an increasing number of deaths due to the exacerbation of pre-existing conditions, and this, Kassebaum told Digital Journal, suggests that more women with health problems are becoming pregnant.
“What we have seen is an increase in the number of US women dying from medical complications of their pregnancies (e.g. embolisms, heart failure, treatment complications), from pregnancy exacerbating their pre-existing medical conditions, and from severe injuries or delayed complications that lead to death six weeks to one year after delivery,” Kassebaum says. “This may mean that more pregnancies in the USA are higher risk than before and/or that higher risk women are not getting the access or follow-up they need.”
The study was instrumental in giving researchers insight into the factors which may be driving the uptick in mortality.
“One of the important findings of this study — the first of its kind to have such detail on timing, causes, maternal age, and geographic levels and trends in maternal mortality — is that the maternal mortality situation is very different depending on where you are looking,” he says. Since there are likely many factors, one way to have a better understanding of what is fueling this problem in the US would be to “…take a page from the UK playbook and enact a ‘Confidential Enquiry’ program to study these maternal deaths in detail and come to a clearer understanding of the challenges of pregnancy and childbirth in the USA.”
Some factors that can play into the rising numbers of maternal death can include older maternal age at birth, increased numbers of women with chronic medical conditions such as diabetes, hypertension and cardiac disease, as well as increasing rates of obesity and cesarean section, says Dr. Siobhan Dolan, medical advisor to the March of Dimes.
There are steps women can take in order to stay healthy during pregnancy.
“Women can seek care before they become pregnant and make sure to focus on taking a prenatal vitamin containing folic acid,” Dolan told Digital Journal.
For women who are thinking about becoming pregnant, Dolan also recommends:
• Maintaining a healthy weight and following weight gain guidelines.
• Avoiding alcohol, smoking and illicit drugs.
• A woman should also review medications with her doctor prior to pregnancy and make certain that medical conditions are being well cared for before and during pregnancy.
• She should also make certain that vaccinations are up-to-date and that all infections are treated.
The study estimates that worldwide 293,000 women died of pregnancy — related causes in 2013, down sharply from 376,000 in 1990, the Post reports.
More about Washington post, Usa today, the lancet, Afghanistan, Greece
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