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Objective: The U.S. pregnancy-related mortality ratio (PRMR) increased since 2004. Since 1999, Florida has performed systematic review of pregnancy-related deaths (PRDs). One goal has been to identify opportunities for prevention. We sought to describe the PRMR trend in Florida and record share the risk factors associated with PRDs.
Study Design: The Florida Pregnancy Associated Mortality Review Committee (PAMR) identifies pregnancy- associated deaths by linking death certificates of reproductive age women to birth and fetal death certificates as well as Florida prenatal screens. Health records of possible PRDs are abstracted, reviewed and assessed by the multi -disciplinary PAMR team. PRD cases from 2007-2016 were analyzed for PRMR trend as well as risk factors.
Results: In 2007-2016, Florida experienced 406 PRDs and 2,217,018 live births. Florida’s PRMR fluctuated from a high of 26.2 deaths per 100,000 live births in 2009, to 12.9 in 2016; 2016 is the lowest PRMR since 1999. Although not significant, there was a trend towards a reduced PRMR from 2009 through 2016. For the period 2007-2016, five causes of death accounted for 68% of PRDs: hemorrhage (21%), infection (15%), hypertensive disorders (14%), cardiomyopathy (9%), and thrombotic embolism (8%). Risk factors associated with PRD were class III obesity (RR 5.7), cesarean delivery (RR 4.2), age 35 or older (RR 3.0), no prenatal care (RR 2.7), non-Hispanic black (RR 2.7), and high school or less education (RR 1.4). PRDs due to ectopic pregnancy and flu-like infections increased between 2009 and 2013.
Conclusion: Contrary to an increasing national trend, Florida’s PRMR trend declined between 2009 and 2016. Hemorrhage and infection were leading causes of PRDs. Obesity and cesarean delivery were leading risk factors. This may reflect combined Florida activities including Florida PAMR efforts, grass roots efforts of the Florida Perinatal Quality Collaborative, and efforts from other professional and community organizations. Florida PAMR should continue focusing on developing Urgent Maternal Mortality Messages, other educational efforts and promote needed women’s health policies and actions. The Florida Perinatal Quality Collaborative should continue to promote quality efforts that contribute to understanding leading causes, risk factors and disparities around maternal mortality.