This publication was produced in 2016, and minor revisions were made in 2017. For more recent data, visit the Division of Reproductive Health website.
Advancing the Health of Mothers in the 21st Century
At A Glance 2016
Maternal health has significantly improved in the 21st century, but too many women continue to die or suffer severe pregnancy complications every year. An increasing number of pregnant women in the United States have chronic conditions such as high blood pressure, diabetes, or heart disease that may put them at risk of pregnancy complications or death.
The Centers for Disease Control and Prevention (CDC) is committed to conducting research and supporting efforts that will help women have safe and healthy pregnancies.
Public Health Problem
Pregnancy-Related Deaths
Despite advances in medicine and medical technologies, the rate of pregnancy-related deaths in the United States has increased over the past 25 years. However, recent data show that this trend may be leveling off.
One in four pregnancy-related deaths are related to heart conditions. Women also die of infections (including flu), bleeding, blood clots, and high blood pressure. Although the risk of dying of pregnancy complications is low, some women are at higher risk than others.
- African American women are 3 to 4 times more likely to die of pregnancy complications than white women.
- Women aged 35 to 39 are almost twice as likely to die of pregnancy complications as women aged 20 to 24. The risk becomes even higher for women aged 40 or older.
Severe Maternal Morbidity
The most severe pregnancy complications, such as a heart attack or hemorrhage, are also known as severe maternal morbidity (SMM). Every year, SMM affects more than 50,000 women in the United States, and this number is increasing.
The rate of SMM more than doubled from 2000 to 2010, leading to higher direct medical costs and extended hospital stays. This increase could be driven by a combination of factors, such as increases in maternal age, prepregnancy obesity, preexisting chronic conditions, and cesarean or other complications during delivery. Tracking SMM cases is one way to identify priority areas for interventions in maternal care, focus quality improvement where it will make the most difference, and determine if these interventions are effective.
Chronic Conditions and Risk Behaviors
A woman’s weight before pregnancy and weight gain during pregnancy are important indicators of the current and future health of both mother and child. Recent CDC studies showed that nearly half of women are overweight or obese before they become pregnant, which is associated with a higher risk of pregnancy complications. Gaining more weight than recommended during pregnancy can result in a baby born at an unhealthy weight and can make it harder for the mother to lose excess weight after delivery. This excess pregnancy weight gain may lead to future obesity for both mother and child. A CDC study showed that, in 2013, nearly half of women gained too much weight during pregnancy.
Maternal smoking is also an ongoing public health problem in the United States. In addition to the well-known health risks for the baby (e.g., preterm birth, sudden infant death syndrome), smoking during pregnancy increases the risk of complications for the mother. These complications can range from problems with the placenta to her water breaking early.
In 2013, about 1 in 5 women smoked in the 3 months before pregnancy, and about 1 in 10 smoked during the last 3 months of pregnancy, according to Pregnancy Risk Assessment Monitoring System (PRAMS) data from 27 states. In addition, about 5% of women used illegal drugs during pregnancy.
Mental health disorders such as depression are also common and can affect the health and well-being of women and their families. About 1 in 9 pregnant women had symptoms of major depression in 2013. However, only about half of pregnant women with depression received treatment for this condition.
Preconception Health
A healthy pregnancy begins long before a woman conceives. Preconception health refers to things women can do before and between pregnancies to increase the chance of having a healthy baby and being a healthy mother. All women of reproductive age should try to adopt a healthy lifestyle and address any health problems. Women should also visit their health care provider if they are thinking about getting pregnant to ensure that they receive the correct medical advice. At every medical visit with women of reproductive age, health care providers should discuss reproductive plans, prescribe contraception if appropriate, and address chronic conditions that could compromise maternal health. Women should contact their provider if they have any concerns during their pregnancy.
CDC’s Response
The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) works in four key areas or domains: epidemiology and surveillance, environmental approaches, health care system interventions, and community programs linked to clinical services. This comprehensive approach supports healthy choices and behaviors, makes healthier options more available, and helps Americans better manage their health.
CDC works with partners—such as public health agencies, other federal agencies, academia, and community organizations—to improve the health of women before, during, and after pregnancy. With $46 million in FY 2016 funding, CDC’s Division of Reproductive Health supports these efforts by focusing its activities in two of NCCDPHP’s four domains: epidemiology and surveillance and health care system interventions.
Epidemiology and Surveillance
Pregnancy Risk Assessment Monitoring System (PRAMS)
In 1987, PRAMS began collecting state-specific population data on maternal attitudes, experiences, and health before, during, and shortly after delivery. This surveillance system helps to identify women and infants at risk of health problems in order to monitor access to care and services, identify changes in behavior and health status, and measure progress in improving health.
State governments use PRAMS data to plan and review programs and policies that improve health for mothers and infants. For example, Mississippi used responses to supplemental questions on flu vaccination during the 2009-2010 flu season to create briefs for pregnant women and their health care providers to increase awareness and promote vaccination. As a result, the Mississippi Office of Women’s Health and the state’s Immunization Program made policy changes to incorporate PRAMS data into their flu vaccination promotion plan and are also exploring the possibility of allocating funds to give pregnant women free or low-cost flu shots.
