{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T14:35:13Z","timestamp":1776954913276,"version":"3.51.4"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T00:00:00Z","timestamp":1624924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R21-HD095236"],"award-info":[{"award-number":["R21-HD095236"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>To better understand age-related disparities in US maternal mortality, we analyzed 2016\u20132017 vital statistics mortality data with cause-of-death literal text (actual words written on the death certificate) added. We created a subset of<jats:italic>confirmed<\/jats:italic>maternal deaths which had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. Age-related disparities were examined both overall and by primary cause. Compared to women &lt;35, the 2016\u20132017 US maternal mortality rate was twice as high for women aged 35\u201339, four times higher for women aged 40\u201344, and 11 times higher for women aged 45\u201354 years. Obstetric hemorrhage was the leading cause of death for women aged 35+ with rates 4 times higher than for women &lt;35, followed by postpartum cardiomyopathy with a 3-fold greater risk. Obstetric embolism, eclampsia\/preeclampsia, and Other complications of obstetric surgery and procedures each had a two-fold greater risk of death for women aged 35+. Together these 5 causes of death accounted for 70.9% of the elevated maternal mortality risk for women aged 35+. The excess maternal mortality risk for women aged 35+ was focused among a few causes of death and much of this excess mortality is preventable. Early detection and treatment, as well as continued care during the postpartum year is critical to preventing these deaths. The Alliance for Innovation on Maternal Health has promulgated patient safety bundles with specific interventions that health care systems can adopt in an effort to prevent these deaths.<\/jats:p>","DOI":"10.1371\/journal.pone.0253920","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T17:39:53Z","timestamp":1624988393000},"page":"e0253920","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Causes contributing to the excess maternal mortality risk for women 35 and over, United States, 2016\u20132017"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4266-3163","authenticated-orcid":true,"given":"Marian F.","family":"MacDorman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Thoma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Declercq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Howell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,29]]},"reference":[{"issue":"4","key":"pone.0253920.ref001","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/AOG.0b013e31829fc38c","article-title":"for the French National Experts Committee on Maternal Mortality. Ten Years of Confidential Inquiries into Maternal Deaths in France, 1998\u20132007","volume":"122","author":"M Suacedo","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"13","key":"pone.0253920.ref002","doi-asserted-by":"crossref","first-page":"E352","DOI":"10.1503\/cmaj.181067","article-title":"Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis","volume":"191","author":"EPIMOMS Study Group","year":"2019","journal-title":"CMAJ"},{"key":"pone.0253920.ref003","volume-title":"Saving Lives, Improving Mothers\u2019 Care\u2014Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015\u201317","author":"M Knight","year":"2019"},{"key":"pone.0253920.ref004","doi-asserted-by":"crossref","first-page":"391.e1","DOI":"10.1016\/j.ajog.2019.02.002","article-title":"Delivery-associated sepsis: trends in prevalence and mortality","volume":"220","author":"AM Kendle","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0253920.ref005","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.ajog.2005.11.008","article-title":"Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality","volume":"194","author":"A.H. James","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"pone.0253920.ref006","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/EDE.0000000000000818","article-title":"Absolute risks of obstetric outcomes by maternal age at first birth: a population-based cohort","volume":"29","author":"L Schummers","year":"2018","journal-title":"Epidemiology"},{"issue":"3","key":"pone.0253920.ref007","doi-asserted-by":"crossref","first-page":"269.e1","DOI":"10.1016\/j.ajog.2019.10.005","article-title":"Pregnant? Validity of the pregnancy checkbox on death certificates in four states, and characteristics associated with pregnancy checkbox errors","volume":"222","author":"A Catalano","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0253920.ref008","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/AOG.0000000000002565","article-title":"Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012","volume":"131","author":"SMA Baeva","year":"2018","journal-title":"Obstet Gynecol."},{"issue":"5","key":"pone.0253920.ref009","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1097\/AOG.0000000000001968","article-title":"Trends in Maternal Mortality by Sociodemographic Characteristics and Cause of Death in 27 States and the District of Columbia","volume":"129","author":"MF MacDorman","year":"2017","journal-title":"Obstet Gynecol."},{"issue":"2","key":"pone.0253920.ref010","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/birt.12330","article-title":"Trends in Texas maternal mortality by maternal age, race\/ethnicity, and cause of death, 2006\u20132015","volume":"45","author":"MF MacDorman","year":"2018","journal-title":"Birth"},{"key":"pone.0253920.ref011","article-title":"Improving US maternal mortality reporting by analyzing literal text on death certificates, United States, 2016\u20132017","author":"MF MacDorman","year":"2020","journal-title":"PlosOne"},{"issue":"9","key":"pone.0253920.ref012","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2021.306375","article-title":"Reexamining racial and ethnic disparities in maternal mortality in the United States using enhanced vital records","volume":"111","author":"MF MacDorman","year":"2021","journal-title":"Am J Public Health"},{"issue":"2","key":"pone.0253920.ref013","article-title":"Maternal mortality in the United States: Changes in coding, publication, and data release, 2018","volume":"69","author":"DL Hoyert","year":"2020","journal-title":"National vital statistics reports"},{"key":"pone.0253920.ref014","volume-title":"Building U.S. Capacity to Review and Prevent Maternal Deaths. Report from nine maternal mortality review committees","author":"CDC Foundation","year":"2018"},{"issue":"4","key":"pone.0253920.ref015","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/AOG.0000000000000746","article-title":"Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities","volume":"125","author":"EK Main","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0253920.ref016","doi-asserted-by":"crossref","first-page":"379.e1","DOI":"10.1016\/j.ajog.2015.05.008","article-title":"Pregnancy-related cardiovascular deaths in California: Beyond peripartum cardiomyopathy","volume":"213","author":"A Hameed","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0253920.ref017","doi-asserted-by":"crossref","first-page":"e0250373","DOI":"10.1371\/journal.pone.0250373","article-title":"The Italian obstetric surveillance system: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths","volume":"16","author":"ITOSS working group","year":"2021","journal-title":"PlosOne"},{"key":"pone.0253920.ref018","unstructured":"Council on patient safety in women\u2019s health care. Patient safety bundles. Available from: https:\/\/safehealthcareforeverywoman.org\/council\/patient-safety-bundles\/maternal-safety-bundles\/."},{"issue":"Suppl 1","key":"pone.0253920.ref019","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s10995-018-2537-7","article-title":"Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health","volume":"22","author":"SL Hans","year":"2018","journal-title":"Matern Child Health J."},{"issue":"1","key":"pone.0253920.ref020","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/AOG.0000000000004206","article-title":"Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit","volume":"137","author":"AM Stuebe","year":"2021","journal-title":"Obstet Gynecol."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T00:37:20Z","timestamp":1672619840000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253920"}},"subtitle":[],"editor":[{"given":"Sara","family":"Ornaghi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,29]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253920","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,29]]}}}