Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Drs Farmakis, Barco, Hobohm, Keller, Mavromanoli, Konstantinides, and Valerio).
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Drs Farmakis, Barco, Hobohm, Keller, Mavromanoli, Konstantinides, and Valerio); Department of Angiology, University Hospital of Zurich, Zurich, Switzerland (Dr Barco).
Am J Obstet Gynecol MFM. 2023 Jan;5(1):100754. doi: 10.1016/j.ajogmf.2022.100754. Epub 2022 Sep 23.
Pulmonary embolism is a leading cause of maternal morbidity and mortality in Western countries. In the United States, pulmonary embolism-related mortality rates have plateaued in the general population after an initial decrease in the past 20 years.
This study aimed to describe the changes in pulmonary embolism-related maternal mortality rates in the United States over the past 2 decades.
In this epidemiologic study of public vital registration data (death certificates encompassing underlying and contributing causes of death) from the Centers for Disease Control and Prevention Multiple Cause of Death database (2003-2020), we identified all maternal deaths with a pulmonary embolism code listed in any position of the death certificates. We investigated the changes in annual crude pulmonary embolism-related maternal mortality rates for the years 2003 to 2020, considering the effect of the introduction of the pregnancy checkbox in death certificates on the pulmonary embolism-related maternal mortality rates.
Overall, 735 pulmonary embolism-related maternal deaths out of 12,871 total maternal deaths (5.7%) were recorded between 2003 and 2020; the overall pulmonary embolism-related maternal mortality rate was 1.02 (95% confidence interval, 0.95-1.10) per 100,000 live births. The pulmonary embolism-related maternal mortality rate increased from 0.93 in 2003 to 1.96 in 2020; however, when accounting for the implementation of the pregnancy checkbox in the death certificates, the trends in pulmonary embolism-related maternal mortality were largely unchanged from 2003 to 2020. The crude pulmonary embolism-related maternal mortality rates differed across maternal age groups (overall 0.61, 1.09, and 3.83 maternal deaths per 100,000 live births for those aged ≤24, 25-39, and ≥40 years, respectively) and racial/ethnicity groups (2.89, 0.47, 0.77, and 0.63 maternal deaths per 100,000 live births for Black non-Hispanics, other non-Hispanics, White non-Hispanics, and Hispanics, respectively).
Maternal mortality rates related to pulmonary embolism did not decrease during the period from 2003 to 2020, as opposed to mortality rates related to pulmonary embolism in the general population. More research is required to assess whether improvement in venous thromboembolism prevention and pulmonary embolism diagnosis and management strategies might reduce death owing to pulmonary embolism in this vulnerable population.
肺栓塞是西方国家孕产妇发病率和死亡率的主要原因。在美国，过去 20 年中，肺栓塞相关死亡率在普通人群中先下降后趋于平稳。
本研究旨在描述过去 20 年美国肺栓塞相关孕产妇死亡率的变化。
本研究为基于公共生命登记数据（涵盖美国疾病控制与预防中心多病因死亡数据库中死亡证明的根本和促成死因的死亡证明）的描述性流行病学研究（2003-2020 年），我们在死亡证明的所有位置列出了肺栓塞代码的所有孕产妇死亡病例。我们研究了 2003 年至 2020 年期间每年的粗肺栓塞相关孕产妇死亡率的变化，同时考虑了死亡证明中引入妊娠复选框对肺栓塞相关孕产妇死亡率的影响。
总体而言，在 2003 年至 2020 年期间，共有 12871 例孕产妇死亡中，735 例（5.7%）与肺栓塞相关；总的肺栓塞相关孕产妇死亡率为每 100000 例活产 1.02（95%置信区间，0.95-1.10）。肺栓塞相关孕产妇死亡率从 2003 年的 0.93 上升到 2020 年的 1.96；然而，考虑到死亡证明中妊娠复选框的实施，2003 年至 2020 年期间，肺栓塞相关孕产妇死亡率的趋势基本保持不变。孕产妇年龄组（24 岁及以下、25-39 岁、≥40 岁的产妇每 100000 例活产分别有 0.61、1.09 和 3.83 例肺栓塞相关死亡）和种族/族裔组（黑人和非西班牙裔、其他非西班牙裔、白人和非西班牙裔、西班牙裔的产妇每 100000 例活产分别有 2.89、0.47、0.77 和 0.63 例肺栓塞相关死亡）的粗肺栓塞相关孕产妇死亡率存在差异。
与普通人群中的肺栓塞死亡率相比，2003 年至 2020 年期间，肺栓塞相关孕产妇死亡率并未下降。需要进一步研究评估改善静脉血栓栓塞预防和肺栓塞诊断及管理策略是否可能降低这一脆弱人群的肺栓塞死亡率。
