Pregnancy-Related Mortality and Severe Maternal Morbidity in Rural Appalachia: Established Risks and the Need to Know More.

ABSTRACT

PURPOSE: The Centers for Disease Control and Prevention (CDC) and the American College of Obstetrics and Gynecology have called for researchers to further elucidate medical and social determinants of pregnancy-related death and severe maternal morbidity. This report begins to answer this call in the context of rural Appalachia. METHODS: This report identifies risk factors exposing women in rural Appalachia to pregnancy-related death and severe maternal morbidity. We also use CDC WONDER data to illustrate rural-urban differences in pregnancy-related death. FINDINGS: Rural women nationally die of pregnancy-related causes at a greater rate than urban women. It is unknown how rurality specifically influences pregnancy-related death, but rural women more often embody multiple risk factors associated with negative maternal outcomes. Established risk factors, including high rates of chronic illness and substance abuse, place rural women at risk for severe maternal morbidity and pregnancy-related mortality. These women may also lack the resources to mitigate these risks, including access to high-risk obstetric care. NEXT STEPS: To address these issues and the concerning lack of data, we propose 4 directions for future study (1) a determination of the prevalence of pregnancy-related death and severe maternal morbidity in this population; (2) an examination of how rural women utilize existing pre- and perinatal resources; (3) better validation concerning surveillance methods of pregnancy-related death and severe maternal morbidity in rural areas; and (4) an exploratory qualitative study of rural women and health care providers.