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Abstract
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BACKGROUND: The Centers for Disease Control and Prevention has reported a steady increase in the United States (US) pregnancy-related mortality ratio since national surveillance began in 1987, though trends are partially induced by concurrent improvements in the identification of pregnancy-related deaths. No prior work has evaluated pregnancy-associated and pregnancy-related mortality among active duty service members, a population with comprehensive health coverage and stable employment.
OBJECTIVE: To assess trends and variation in pregnancy-associated and pregnancy-related mortality in the US military. STUDY DESIGN: Live births to active duty service members were captured in Department of Defense (DoD) Birth and Infant Health Research program data, 2003-2014. Pregnancy-associated deaths (deaths temporally related to pregnancy from any cause) were identified through one year after pregnancy end date using National Death Index Plus (NDI+) data from the Joint DoD-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 NDI+ data, administrative medical encounter data, and chart review. Pregnancy-related deaths were reported including and excluding deaths due to 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/ethnicity, and marital status. Timing of death in relation to pregnancy end date was assessed by cause of death.
RESULTS: A total of 179,252 live births occurred to active duty service members, 2003-2014. Pregnancy-associated and pregnancy-related mortality ratios were 41.3 (95% confidence interval [CI]: 32.4-51.8) and 18.4 (95% CI: 12.7-25.9), respectively. Excluding deaths from suicide and unintentional overdose, the pregnancy-related mortality ratio was 11.2 (95% CI: 6.8-17.2). Deaths from suicide and unintentional overdose comprised 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 postpartum; in contrast, deaths due to suicide, overdose, assault, and undetermined intent were more likely to occur between 42 days and one year postpartum.
CONCLUSION: Pregnancy-associated and pregnancy-related deaths varied over time and by age and race/ethnicity. Suicide and overdose are major recent causes of pregnancy-related mortality among active duty service members.
Language: en |