TOPLINE: 

Among 5309 pregnancy-related deaths identified in the CDC’s Pregnancy Mortality Surveillance System (PMSS) during 2012-2019, 694 (13.1%) were due to infection, with sepsis accounting for 46.4% of infection-related deaths. Endocarditis-related deaths (12.4%) showed the most significant increase in pregnancy-related mortality ratio .

METHODOLOGY:

• Researchers analyzed data from the CDC’s PMSS covering deaths during or within 1 year after pregnancy, from 2012 to 2019, with COVID-19 pandemic years excluded to avoid masking other infection patterns.
• Analysis included death records and linked live birth or fetal death records from all states, the District of Columbia, and New York City, which were reviewed by medically trained epidemiologists to determine pregnancy-relatedness and cause.
• Pregnancy-related deaths were classified into 10 mutually exclusive categories, with infection deaths further subclassified and analyzed by sociodemographic characteristics to calculate pregnancy-related mortality ratios per 100,000 live births.

TAKEAWAY:

• Sepsis was the predominant cause of infection-related mortality at 46.4% of cases, followed by nonpelvic infection at 25.2% and endocarditis at 12.4%.
• Endocarditis-related deaths showed the most significant increase in pregnancy-related mortality ratio, rising from 0.10 in 2012 to 0.56 in 2019.
• Among endocarditis-related deaths, 79.1% occurred in non-Hispanic White women, representing a notable demographic pattern.
• The pregnancy-related mortality ratios for chorioamnionitis and urinary tract infection remained consistently low at less than 0.20 across all time periods. 

IN PRACTICE:

“The reason for the increase in endocarditis-related deaths cannot be determined from this dataset. However, the prevalence of substance use disorder among pregnant and postpartum women with infective endocarditis approached 90% in two U.S. cohorts; this may have contributed to the increased incidence,” wrote the authors of the study. “Participation of multidisciplinary care teams—including experts in addiction medicine, cardiology, infectious disease, and others—has been recommended to improve outcomes,” they added.

SOURCE:

The study was led by Fanny Njie, MPU, Tanaq Support Services in St. George Island, and the Division of Reproductive Health, CDC, in Atlanta. It was published online in Obstetrics & Gynecology.

LIMITATIONS: 

According to the authors, data are limited by the completeness and accuracy of original records, which could potentially lead to misclassification of pregnancy-related deaths. Additionally, in some cases, the underlying cause of infection that led to sepsis may not have been identified on the death record, potentially resulting in underreporting in other specific subclassifications. 

DISCLOSURES:

The authors did not report any potential conflicts of interest. The findings and conclusions presented do not necessarily represent the official position of the CDC.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.