title: The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Hawaii, John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI 96826, USA. burlinga@hawaii.edu
authors.forename: J
authors.initials: J
authors.lastname: Burlingame
authors.forename: B
authors.initials: B
authors.lastname: Horiuchi
authors.forename: P
authors.initials: P
authors.lastname: Ohana
authors.forename: A
authors.initials: A
authors.lastname: Onaka
authors.forename: L M
authors.initials: LM
authors.lastname: Sauvage
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D055815:Young Adult