Pregnancy-related mortality among women aged 35 years and older, United States, 1991-1997

OBJECTIVE: To describe pregnancy-related deaths among women 35 years and older and to compare their risk of death to that for 25-29-year-old women. METHODS: Pregnancy-related deaths in the United States among women 35 years and older from 1991 through 1997 were identified through the Center for Disease Control and Prevention's Pregnancy Mortality Surveillance System. Pregnancy-related mortality ratios (deaths per 100,000 live births) and risk ratios (compared with 25-29-year-old women) for women 35-39 years old or 40 years and older were calculated and stratified by race, obstetric and demographic variables, and cause of death. RESULTS: There was an excess risk of death for women 35 years and older regardless of parity, time of entry into prenatal care, and level of education. Among white women, the risk ratios for death from hemorrhage, infection, embolisms, hypertensive disorders of pregnancy, cardiomyopathy, cerebrovascular accidents, or other medical conditions ranged from 1.8 to 2.7 for those aged 35-39 years and from 2.5 to 7.9 for those 40 years and older. Among black women the risk ratios for death from these conditions ranged from 2.0 to 4.1 for those aged 35-39 years and from 4.3 to 7.6 for those 40 years and older. CONCLUSION: Recognition of the risk of death borne by older pregnant women is needed to inform their care before, during, and after pregnancy. Thorough review of all maternal deaths as a core public health function may shed light on the reasons for excess pregnancy-related mortality among older women. (C) 2003 by The American College of Obstetricians and Gynecologists.