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Maternal mortality related to pulmonary embolism in the United States, 2003–2020

  • Ioannis T. Farmakis
    Affiliations
    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)
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  • Stefano Barco
    Affiliations
    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)
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  • Lukas Hobohm
    Affiliations
    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 Cardiology, University Medical Center Mainz, Mainz, Germany (Drs Hobohm, Keller, and Valerio)
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  • Sigrid K. Braekkan
    Affiliations
    Thrombosis Research Center (TREC), Department of Clinical Medicine, University of Tromsø – The Arctic University of Norway, Tromsø, Norway (Dr Braekkan)

    Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway (Dr Braekkan)
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  • Jean M. Connors
    Affiliations
    Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr Connors)
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  • George Giannakoulas
    Affiliations
    Department of Cardiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (Dr Giannakoulas)
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  • Beverley J. Hunt
    Affiliations
    St Thomas’ Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology Group, Guy's and St Thomas’ National Health Service Foundation Trust, London, United Kingdom (Dr Hunt)
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  • Karsten Keller
    Affiliations
    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 Cardiology, University Medical Center Mainz, Mainz, Germany (Drs Hobohm, Keller, and Valerio)

    Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany (Dr Keller)
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  • Anna C. Mavromanoli
    Affiliations
    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)
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  • Alice Trinchero
    Affiliations
    Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland (Dr Trinchero)
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  • Stavros V. Konstantinides
    Affiliations
    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 Cardiology, Democritus University of Thrace, Komotini, Greece (Dr Konstantinides)
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  • Luca Valerio
    Correspondence
    Corresponding author: Luca Valerio, MD.
    Affiliations
    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 Cardiology, University Medical Center Mainz, Mainz, Germany (Drs Hobohm, Keller, and Valerio)
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Published:September 22, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100754

      BACKGROUND

      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.

      OBJECTIVE

      This study aimed to describe the changes in pulmonary embolism–related maternal mortality rates in the United States over the past 2 decades.

      STUDY DESIGN

      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.

      RESULTS

      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).

      CONCLUSION

      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.

      Key words

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