Pregnancy-associated and pregnancy-related deaths in the United States military, 2003–2014 - 23/08/22
Abstract |
Background |
The Centers for Disease Control and Prevention has reported a steady increase in the US pregnancy-related mortality ratio since national surveillance began in 1987, although trends are partially induced by concurrent improvements in the identification of pregnancy-related deaths. No previous work has evaluated pregnancy-associated and pregnancy-related deaths among active-duty service members, a population with comprehensive health coverage and stable employment.
Objective |
This study aimed to assess trends and variations in pregnancy-associated and pregnancy-related deaths in the US military.
Study Design |
Live births to active-duty service members were captured in Department of Defense Birth and Infant Health Research program data from 2003 to 2014. Pregnancy-associated deaths (deaths temporally related to pregnancy from any cause) were identified through 1 year after pregnancy end date using National Death Index Plus data from the Joint Department of Defense and Department of Veterans Affairs Suicide Data Repository. Pregnancy-associated deaths were classified as pregnancy-related (causally related to pregnancy) based on cause-of-death codes in the National Death Index Plus data, administrative medical encounter data, and medical record review. Pregnancy-related deaths were reported including and excluding deaths from suicide and unintentional overdose. Mortality ratios (deaths per 100,000 live births) were reported overall, triennially, and by selected characteristics; the relative contribution of each cause of death to all pregnancy-associated deaths was reported overall and by age, race and ethnicity, and marital status. Timing of death relative to pregnancy end date was assessed by cause of death.
Results |
A total of 179,252 live births occurred to active-duty service members from 2003 to 2014. Pregnancy-associated and pregnancy-related mortality ratios were 41.3 (95% confidence interval, 32.4–51.8) and 18.4 (95% confidence interval, 12.7–25.9), respectively. Excluding deaths from suicide and unintentional overdose, the pregnancy-related mortality ratio was 11.2 (95% confidence interval, 6.8–17.2). Deaths from suicide and unintentional overdose composed a larger proportion of pregnancy-related deaths over time and accounted for 17.6% of all pregnancy-associated deaths. Deaths from other pregnancy-related causes accounted for a greater share of deaths among older vs younger service members (≥30 years: 41.2%; 18–29 years: 22.8%) and non-Hispanic Black vs White service members (33.3% vs 24.1%). Pregnancy-related deaths, excluding suicide and unintentional overdose, were more likely to occur within 42 days of pregnancy end date; in contrast, deaths from suicide, overdose, assault, and undetermined intent were more likely to occur between 42 days and 1 year after pregnancy.
Conclusion |
Pregnancy-associated and pregnancy-related deaths varied over time and by age and race and ethnicity. Suicide and overdose are major recent causes of pregnancy-related death among active-duty service members.
Le texte complet de cet article est disponible en PDF.Key words : maternal death, maternal mortality, military health system, obstetrics, service members
Plan
The authors report no conflict of interest. |
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This work was supported by the US Navy Bureau of Medicine and Surgery (BUMED) under work unit number 60504. |
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AMSC is a military service member or employee of the US Government. This work was prepared as part of their official duties. Title 17, USC. §105 provides that protection under this title is not available for any work of the US Government. Title 17, USC. §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. |
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Report number 22-01 was supported by the US Navy BUMED under work unit number 60504. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US Government. |
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The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.1999.0003. |
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Cite this article as: Romano CJ, Hall C, Bukowinski AT, et al. Pregnancy-associated and pregnancy-related deaths in the United States military, 2003–2014. Am J Obstet Gynecol 2022;227:508.e1-9. |
Vol 227 - N° 3
P. 508.e1-508.e9 - septembre 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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