The US has highest rate of pregnancy-related death among high-income countries | Hacker News Reader

The US has highest rate of pregnancy-related death among high-income countries

jamanetwork.com

39 pointscar23 comments

> American Indian and Alaska Native women had the highest age-standardized annual and aggregated rate (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births)

I haven't looked into this study but those are populations that generally have a higher level of obesity and also smoking, alcohol & recreational drug use. They also tend to have somewhat lower access to high quality health care. All of which are correlated with increased health issues like lower resistance to infection, less resilience to physical stress, slower recovery times, increased incidence of complications, higher blood pressure, diabetes, etc. And pregnancy is basically a massive, system-wide physical stressor.

My wife is physically fit and super athletic. No smoking, alcohol or drugs before or during pregnancy (as well as zero junk food before or during). And, unsurprisingly, her pregnancy was basically ideal. She had an easier time than any of her friends, but it still kicked her ass - especially the final trimester (fatigue, poor sleep, hormonal swings, etc). She joked it felt like birthing a face hugger from the movie Aliens. Her friends who already had underlying conditions or overall weaker health generally also had the roughest pregnancies, and many of them had various medical complications. They also had higher incidence, severity and duration of post-partum depression which can be a big issue (fortunately, my wife had virtually none). Plus my wife only worked minimally and entirely by choice while having great medical care that was local and which she knew how to fully utilize.

This is misleading when you dig into the data. For starters every state and nation does not record deaths and causes of death consistently, so there's a lot of apples and oranges comparisons going on. Second, in the US depending on the state, any death within 90 days of giving birth is labeled as a pregnancy-related death. The person could be hit by a car, or die of a drug-overdose, and it would be still be identified as a pregnancy related death.

> any death within 90 days of giving birth is labeled as a pregnancy-related death. The person could be hit by a car, or die of a drug-overdose, and it would be still be identified as a pregnancy related death.

Citation needed.

*The CDC directly refutes this claim.

> The Centers for Disease Control and Prevention (CDC) conducts national surveillance to better understand the causes of pregnancy-related deaths. The Pregnancy Mortality Surveillance System (PMSS) defines a pregnancy-related death as a death during or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy. Medical epidemiologists review and analyze applicable vital records, and additional available data from all 50 states, New York City, and Washington, DC. Beginning in 2020, data from Puerto Rico are included, and in 2021, data from Northern Mariana Islands are included in PMSS.

https://www.cdc.gov/maternal-mortality/php/pregnancy-mortali...

“Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behavior disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death”

Hmmm. What's unique about pregnancy in the US compared to other high-income countries I wonder? /s

For one, a higher proportion vs pretty much all other high income countries of the two groups that dragged it down the most, 'native americans' and 'blacks' (for whatever definition of that this study used).

Two high-risk demographics for inadequate medical care. Something I hadn't thought about up until this point, would socialized healthcare improve the situation for natives? I foresee a lot of legal boilerplate and additional acts required to interface with the reservations on a healthcare basis. On top of that, the wealthy reservations already have their own system which is much more equitable than the national one. The reservations that are struggling, where these figures are the worst, are very rural. I'm not aware of any country where rural access to healthcare is "very good". Certainly we'd see some kind of improvement with stronger, more centralized federal support... but would we even reach adequate levels?

There already is socialized medicine provided to native Americans (IHS, if you were not aware).

Just because the program exists doesn't mean native americans are getting good access to healthcare.

Likewise you'd expect that native americans would have access to drinking water given that the government provides some amount of guarantees for that as well but substantial portions of the reservations in the southwest have been systematically denied water rights and as such have limited access to drinking water.

You made my point exactly. Why do you think "socialized healthcare" would ameliorate the situation that native Americans are high risk?

I don't know why you would as it ignores half of all pregnant Americans, but if you exclude all groups except white women the age-standardized annual and aggregated rate of pregnancy-related mortality is still 27.6 deaths per 100,000 pregnancies.

Double that of Europe.

That is pathetic and unquestionably attributable in large part to our shitty and broken healthcare disaster.

>In the US, homicide, suicide, and drug overdose are the leading causes of pregnancy-associated death

If you kill yourself with recreational drugs or intentionally that is not pregnancy-related/associated, except by the most disingenuous peddlers who want to go on a semantic crusade about what 'related'/'associated' is in order to push their agenda.

Post-natal depression affects many mothers who subsequently go on to have happy lives.

Suicide among new mothers has a terrible effect on their surviving family and friends. Anything that can be done to reduce this death rate must be worth considering.

Why do more pregnant Americans commit suicide?

That's not how "pregnancy-related" is calculated in the US. As the source link notes, deaths occuring up to 1 year after giving birth can be considered pregnancy-related.

No, it doesn't, at all:

> within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy

We have you here saying "If you overdose on recreational drugs a year after giving birth that's considered pregnancy-related" - no it's not. Just as elsewhere someone is claiming "If you die in a car accident six months after giving birth, that's pregnancy-related".

Too many people think they have these "gotcha" moments that they think have uncovered some ideological agenda in this data, but in reality, it only uncovers their own agenda. The same was true a few years ago - "if you fall down the stairs and die a year after having COVID, that will be counted as a COVID death". Again, no, it won't.

The source article says that "mental and behavior disorders and drug and alcohol induced death contributed to 21.2% of late maternal deaths". It seems clear that at least some drug overdoses are being counted in the late maternal deaths subcategory.

(The article also says "homicide, suicide, and drug overdose are the leading causes of pregnancy-associated death", although they do take care to note that pregnancy-associated is a broader category which statistics don't typically include.)

That's... incredibly unhelpful, although I suppose it explains why the US has more of these deaths than other countries: accounting practices.

The US has some of the highest levels of public health research (NIH) and science funding (NSF). And despite not having universal healthcare, we have I think the highest government funded health care spending in the world (~8% of GDP or ~2 Trillion).

Part of the way to gain this funding is to label things 'associated' or 'related' in order to trigger a funding grab for your particular field of interest. NIH and NSF funding is mostly adversarial, for the most part the pot is fixed and you can win by making your case more dire than the other guy. Thus you have weird stuff like anything remotely having a connection to COVID or pregnancy getting tagged in to influence the purse strings.

One would hope any study comparing statistics between countries would normalize for differences in thresholds and time frames. But maybe not?

It's a systemic problem.

The people crunching the numbers want to leave open the door to future research. If they ask X and crunch numbers and get answer Y but think it could be explained by Z they'll just leave it at Y and make Z it's own follow up so then can get credit for two rather than one. The people summarizing it for mass market consumption have every incentive to go with the most outrageous interpretations of Y because that's what grabs eyeballs and that's how they get paid.

And this is before you account for all the bad actors who'll willfully make little "oversights" like not correcting for stats across countries because they or their backers or colleagues they're trying to curry favor with have an axe to grind and want to see a particular result.

How do you know it's not the other way around -- more suicidal people become pregnant?

I would not be surprised if you plan to kill yourself (or too high to care) you might not use protection and fuck freely. What would be the point in preventing pregnancy if you didn't plan on living anyway?

Reply on news.ycombinator.com