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Child Health USA 2013 An illustrated collection of current and historical data, published annually.

Maternal Morbidity

Narrative

Diabetes and hypertension are the most commonly reported health conditions among pregnant women. Diabetes, both chronic and gestational (developing only during pregnancy), may pose health risks to a woman and her baby. Women with gestational diabetes are at increased risk for developing diabetes later in life.1 In 2011, among the 36 states and District of Columbia that collected this information on the revised birth certificate, chronic or pre-existing diabetes was reported in 7.4 per 1,000 live births while gestational diabetes was reported in 48.2 per 1,000 live births. Chronic diabetes was highest among non-Hispanic American Indian/Alaska Native mothers (17.0 per 1,000 live births) and lowest among non-Hispanic White and non-Hispanic Asian mothers (6.4 and 6.6 per 1,000, respectively). However, non-Hispanic Asian mothers had the highest rate of gestational diabetes at 86.8 per 1,000 live births, followed by non- Hispanic Native Hawaiian/Pacific Islander (65.8 per 1,000).

Hypertension during pregnancy can also be either chronic in nature or gestational. Severe hypertension during pregnancy can result in preeclampsia, fetal growth restriction, and early delivery.2 In 2011, in the 36 states and District of Columbia that used the revised birth certificate, chronic and pregnancy-associated hypertension was reported in 14.0 and 44.8 per 1,000 live births, respectively. Chronic hypertension was most common in non-Hispanic Black women (29.0 per 1,000 live births) and least common among Hispanic and non-Hispanic Asian women (7.7 and 7.9 per 1,000, respectively). Pregnancy-associated hypertension was reported in about 50 per 1,000 live births to non-Hispanic Black, non-Hispanic American Indian/Alaska Native, and non-Hispanic White mothers and was lowest among non-Hispanic Asian mothers (24.8 per 1,000). Although these conditions are known to be under-reported on the birth certificate, patterns by race and ethnicity are not likely to be affected.3

A recent national study of hospital discharge data found that severe maternal morbidity, which includes life-threatening complications such as kidney or heart failure, blood clots, infection, and hemorrhage, occurs at a rate of 12.9 per 1,000 delivery hospitalizations.4 Severe maternal morbidity is more than 100 times as common as pregnancy-related mortality—translating to about 52,000 women affected annually—and it is estimated to have increased by 75 percent over the past decade. Rises in chronic conditions, including obesity, diabetes, hypertension, and cardiovascular disease, are likely to have contributed to this increase.

1 Centers for Disease Control and Prevention. Diabetes in Pregnancy. Accessed: 04/24/13.

2 American Congress of Obstetricians and Gynecologists . High Blood Pressure During Pregnancy. Accessed 06/27/11.

3 Martin JA, Wilson EC, Osterman MJK, et al. Assessing the quality of medical and health data from the 2003 birth certificate revision: Results from two states. National Vital Statistics Reports; Vol 62 No. 2. Hyattsville, MD: National Center for Health Statistics, 2013.

4 Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012 Nov;120(5):1029-36.

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Graphs

This image is described in the Data section.

maternal borbidities and risk factors in pregnancy graph

Data

Selected Maternal Morbidities and Risk Factors in Pregnancy, by Race/Ethnicity, 2011*
Race/Ethnicity Chronic Diabetes Rate per 1,000 Live Births Gestational Diabetes Rate per 1,000 Live Births Chronic Hypertension Rate per 1,000 Live Births Pregnancy-Associated Hypertension Rate per 1,000 Live Births
*Data are from 36 states and the District of Columbia that implemented the 2003 revision of the death certificate as of January 1, 2011, representing 83 percent of all U.S. births.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. 2011 Natality File. Analysis conducted by the Maternal and Child Health Bureau.
Non-Hispanic White 6.4 45.6 13.5 49.0
Non-Hispanic Black 9.9 40.1 29.0 56.6
Hispanic 7.8 50.3 7.7 33.8
Non-Hispanic American Indian/Alaska Native 17.0 52.3 18.6 49.1
Non-Hispanic Asian 6.6 86.8 7.9 24.8
Non-Hispanic Native Hawaiian/Other Pacific Islander 13.0 65.8 14.5 44.8
Non-Hispanic Multiple Race 7.8 45.0 15.5 45.7
Total 7.4 48.2 14.0 44.8