Pregnancy outcomes and a newborn's health are affected by the health of a woman before, during and after pregnancy. Before 1930, six to nine women and 100 infants (before age 1) died for every 1,000 births. ⁽¹⁾   Though recorded U.S. maternal deaths dropped from 670.0 per 100,000 births in 1930 to 7.5 in 1997,⁽²⁾   Healthy People 2000 estimated that maternal deaths could be further reduced by more than half to 3.3 per 100,000 live births.^(2-4)

Figure 2: Florida Fetal Deaths by Race/Ethnic Group in 1998, 1999 and 2000

Florida's average maternal mortality rate has been historically high compared to other states, but is improving. The Centers for Disease Control and Prevention reported Florida's average maternal mortality of 24.8 per 100,000 live births for 1987 through 1996 was only exceeded by New York (28.7), Kansas (27.3), and the District of Columbia (25.7). There are measurement challenges in understanding the risk of death for women from pregnancy. U.S. maternal deaths are estimated to be two to three times higher than reported in vital statistics due to under identification in death certificate data. ⁽²⁾  The definition of maternal death changed in 1999. For 1998 and prior years, maternal death are defined as occurring within a 42-day post-pregnancy interval and are assigned to ICD9 codes 630-676 codes. For 1999 and forward maternal deaths are assigned to ICD10 codes 000-099 codes regardless of time interval. (Florida Vital Statistics Annual Report 2000, p.83) This change reflected the fact that women also die from pregnancy-associated illnesses after 42 days. ⁽⁵⁾ Florida conducts Pregnancy Associated Mortality Reviews (PAMR) on Florida women with a recorded birth or fetal death. The 1997-1999 PAMR report found the time of greatest risk for maternal death was the postpartum period consisting of up to one year after delivery (62 percent) and secondly, labor and delivery (23 percent). Major chronic illnesses or conditions associated with maternal death were obesity (25 percent) hypertension (16 percent) and vaginal infections including sexually transmitted diseases (7 percent). The major medical problems during pregnancy included infection (36 percent), obesity (24 percent), anemia and hypertension (16 percent each) and preterm labor (14 percent).

Fetal deaths are those that occur before 20 weeks or more of gestation. While fetal deaths have increased each year since 1996 (from 7.8 to 8.2 per 1,000 live births in 2000), infant deaths decreased between 1996 and 2000 (from 7.4 to 7.0 per 1,000 live births). Fetal deaths and maternal deaths occur to black women over two times as often as white women.