Pregnancy-related mortality in New Jersey, 1975 to 1989.

OBJECTIVES: National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. METHODS: Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. RESULTS: The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. CONCLUSIONS: New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women.

Trends in cesarean section rates.

Analysis of rates of primary cesarean section by level of perinatal designation and of individual hospitals with rates in excess of 20 percent show the increased utilization of cesarean sections between 1967 and 1986. Recommendations are made for reducing the utilization of cesarean sections at the hospital and physician levels.

Central nervous system malformations in relation to two polyvinyl chloride production facilities.

A modified case-control study was conducted for selected birth defects that occurred among residents who lived in areas that surrounded two vinyl chloride polymerization facilities in New Jersey. Odds ratios for central nervous system defects (ICD 9, 740-742) decreased as the distance the mothers' residences were located from the facilities increased. Higher odds ratios for central nervous system birth defects were found in the areas around the plant that had higher vinyl chloride emissions. None of the odds ratios, however, were statistically significant. The differences in concentrations of emissions from the different plants may contribute to the discrepancies reported in previous studies wherein the risk of environmental exposure to vinyl chloride was assessed.

Pregnancy-associated deaths due to AIDS in the United States.

From 1981 to 1988, eighty percent of all women with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control were of reproductive age. Six pregnancy-associated deaths due to AIDS in this country have been reported in the medical literature. We identified 20 unpublished cases of women who died of AIDS during or within one year after termination of pregnancy. Analysis showed that these women were mostly black or Hispanic, half were intravenous drug abusers, and most died of Pneumocystis carinii pneumonia. Each pregnancy had an obstetric complication, primarily preterm delivery. The interval between diagnosis of AIDS and the death of these women ranged from one day to 15 months, with a mean interval of 113 days. Multiple reporting sources increased case detection and should be used for future investigations. Prospective case-control studies are needed to determine any further relationship between pregnancy complications and AIDS.

Increased infant mortality in Jersey City.

The infant mortality rate for 1982 in Jersey City, a medium-sized urban community, was found to have increased sharply from that for 1981. An investigation by health officials revealed that the increase occurred only among infants delivered to Jersey City residents at a large local municipal hospital. An increase in the incidence of newborns with birth weights of 501-1,000 grams (g) and a decrease in their survival rate accounted for much of the increase. Although local increases in infant mortality are reported in the lay press, the articles usually lack any meaningful analyses. Furthermore, investigations of such increases have not been described in the medical literature. This report describes the investigation of the rise in infant mortality for Jersey City, demonstrates how local officials can approach the problem, and indicates how essential the availability of linked birth and infant death records are to the effort.