The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system

Objective:the objective of this study was to demonstrate the increasing importance of heart disease as a cause of pregnancy-related mortality in hawaii and the rest of the united states.study design:hawaii's department of public health identified all pregnancy-associated death certificates from 1991 to 2007. hospital records and autopsy reports were reviewed to determine whether deaths were pregnancy-related.result:from 1991 to 2007, hawaii registered 156 deaths occurring within 1 year of pregnancy, which represented 4.2% of the total number of women who died in the same 17 to 46 years age group and 9.0% of the total number of women who died in the same 17 to 34 years age group. the pregnancy-related mortality ratio was 22.4 and the pregnancy-associated mortality ratio was 50. the leading cause of pregnancy-associated mortality was heart disease (20.5%) followed by cancer (18.6%) and suicide/homicide (12.2%). pregnancy-related deaths (n=70) were attributed to heart disease (45.7%) followed by sepsis (14.2%) and hemorrhage (12.9%). the new hawaii death certificate beginning in 2006 increased the detection of both pregnancy-related and -associated deaths.conclusion:heart disease is the most common cause of pregnancy-related mortality in hawaii, and with improved ascertainment, may be determined to be the most common cause of pregnancy-related mortality in the rest of the united states.