Compiled by Lois Bloebaum, BSN, MPA
Maternal mortality is an important health indicator reflecting a nation’s health status. Though maternal mortality has decreased by 99% since the 1900s, maternal deaths currently remain significant events. Maternal deaths in Utah are classified as either pregnancy-associated (PA) or pregnancy-related (PR). A pregnancy-associated death is the death of any woman from any cause while pregnant or within one year of termination of pregnancy. A pregnancy-related death is defined as a subset of pregnancy-associated deaths resulting from 1) complications of the pregnancy, 2) the chain of events initiated by the pregnancy or 3) aggravation of an unrelated condition by the physiologic or pharmacologic effects of the pregnancy. This expanded definition used by the Utah Department of Health (UDOH) is different than that used by the National Center for Health Statistic’s definition and has been promoted by the Centers for Disease Control and Prevention to more clearly reflect the problem. Maternal death surveillance is carried out by the Perinatal Mortality Review Program (PMRP) of the UDOH.
The PMRP is a public health approach to improving perinatal outcomes. Through individual case reviews with a committee of perinatal healthcare professionals, opportunities for prevention are identified. This report outlines characteristics of maternal deaths in Utah from 1995-2002 and compares these results to a previous analysis completed for a period from 1982-1994. Maternal mortality rates were calculated by identifying the number of maternal deaths, then dividing by the total number of live births registered in the state of Utah during the time periods with the quotient being multiplied by 100,000.
From 1982-1994, there were 62 maternal deaths reviewed resulting in a mortality rate of 12.8/100,000 live births. From 1995-2002, 61 maternal deaths were reviewed resulting in a mortality rate of 16.9/100,000 live births. The increase in maternal deaths from 1995-2002 may be attributable to improvements in pregnancy mortality surveillance over this time period. In 1995, the UDOH established the PMRP through which improved identification of maternal deaths was made a priority.
Among the 61 maternal deaths from 1995-2002, 32 deaths were categorized as pregnancy-associated and 29 as pregnancy-related. Injury, embolism, and cardiac events were the three leading causes of maternal deaths during this time period. Injury was the leading cause of all pregnancy-associated deaths, while embolism was the leading cause of all pregnancy-related deaths. Similar results were obtained in the 1982-1994 time period.
The risk of maternal mortality increases with progressive maternal age. The rate of mortality was lowest in women ages 20-24 years, and increased in a linear trend for all older age groups. In this analysis, maternal mortality rates were also noted to be highest among the underweight and obese women. Of the 61 maternal deaths from 1995-2002, approximately one-third of women had a pre-pregnancy body mass index (BMI) categorized as overweight (BMI=25-29) or obese (BMI >29).
The Utah Department of Health continues to implement the PMRP in an effort to identify opportunities for preventing future maternal deaths. The Reproductive Health Program of the UDOH utilizes PMRP findings to inform the development of policy and program decisions to improve the health of Utah women and their infants.