On this page—

• Depression
• Obesity
• Gestational Diabetes
• Maternal Morbidity
• Pregnancy-related Death

Safe motherhood begins before conception with proper nutrition and a healthy lifestyle and continues with appropriate prenatal care, the prevention of complications, and the early and effective treatment of complications. The ideal result is a full-term pregnancy, the delivery of a healthy infant, and a healthy postpartum period in a positive environment that supports the physical and emotional needs of the woman, infant, and family.

Unfortunately, pregnancy complications still do occur. CDC’s Division of Reproductive Health conducts research to understand the burden of maternal complications and death and to decrease disparities among populations at risk of death and complications from pregnancy.

Approximately 1 of 10 women are depressed during any trimester of pregnancy, or any month within the first year after delivery. The consequences of depression can be devastating, inhibiting the woman’s ability to perform daily activities, to bond with her infant, and relate to her family. Previous studies have found that history of depression is one of the greatest risk factors for postpartum depression.

In a recent study among 4,400 pregnant women, CDC and collaborators found that more than half of the women who developed postpartum depression had also been depressed during pregnancy or in the 9 months before pregnancy. Researchers found a high level of treatment among women identified with depression, which suggests that women are willing to obtain treatment if they are identified and referred for depression.

Depression affects a substantial proportion of women around the time of pregnancy. Continuity of care and routine screening of women for depression during pregnancy may help to uncover undetected depression and offer an opportunity for appropriate treatment.

the following resources are available to help women suffering from pregnancy-related depression:

• Postpartum Depression (Medline Plus)

• Postpartum Depression fact sheet (National Women's Health Information Center)
  Also available in Spanish

Depression During and After Pregnancy: A Resource for Women, Their Families, and Friends
A new booklet on perinatal depression released by the Health Resources and Services Administration (HRSA) contains tips on identifying the condition in mothers and offers six steps to help treat it successfully. Perinatal depression includes a broad range of physical and emotional symptoms that many women face during pregnancy or within a year following the birth of a child.

Maternal obesity during pregnancy is associated with many complications such as cesarean delivery, macrosomia, gestational hypertension, preeclampsia, gestational diabetes mellitus, fetal death, and possible birth defects. Maternal obesity also increases the long-term risks for the fetus. Children born to obese mothers are twice as likely to be obese and to develop type 2 diabetes later in life. Obesity during pregnancy is also associated with greater use of health care services and longer hospital stay. Moreover, the prevalence of obesity is increasing among women in the United States. Currently 1 of 5  women are obese at the beginning of pregnancy. (Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in Pre-pregnancy Obesity in Nine States, 1993–2003. Obesity 2007;15:986–993.) Given the health and economic costs, efforts to prevent obesity and maintain a healthy weight in young women should be a public health priority. This can better enhance overall health during pregnancy and throughout the woman’s life.

Gestational Diabetes Mellitus (GDM)

Because more than 80% of women will deliver an infant in their lifetime, pregnancy provides an opportunity for identifying, intervening, and preventing chronic diseases, such as diabetes and cardiovascular disease, later in life. Gestational diabetes mellitus, or GDM, is a carbohydrate intolerance leading to hyperglycemia with onset during pregnancy. It affects 2% to 10% of pregnancies in the United States. Although this carbohydrate intolerance usually resolves after delivery, up to one-third of affected women have diabetes or impaired glucose metabolism at their postpartum screening. An estimated 15% to 50% will develop diabetes in the decades following the affected pregnancy.

Screening for GDM during prenatal care is nearly universal. Although most major organizations, such as the American College of Obstetricians and Gynecologists and the American Diabetes Association, recommend postpartum glucose testing to detect diabetes or other impaired glucose metabolism, less than half of women with a diagnosis of GDM obtain a postpartum glucose test.

Evidence is accumulating that among women with a history of GDM, undiagnosed diabetes in subsequent pregnancies, and progression to type 2 diabetes later in life can be prevented or delayed. Studies have shown that lifestyle modification including a healthy diet, exercise, weight management, and sometimes medication are effective. Despite the lack of uniformity in recommendations, all women who have had GDM should have blood glucose tests on a regular basis after their postpartum visit. In addition, all women with GDM should be educated about their diabetes risk and the importance of communicating their obstetrical history to their health care providers.

CDC activities regarding GDM address 4 main areas:

• Building partnerships to strengthen prevention efforts of type 2 diabetes mellitus among women diagnosed with GDM
• Monitoring trends and risk factors in GDM
• Improving postpartum screening for diabetes
• Improving long-term follow up of women with a history of GDM (e.g. periodic glucose testing , counseling about diabetes prevention)

Other research has included a meta-analysis conducted to estimate the magnitude of the association between prepregnancy body mass index (BMI) and GDM risk. Authors found that the risk for developing GDM increased substantially as women’s BMI increased. (Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007 Aug;30(8):2070–2076.)

Maternal Morbidity (Pregnancy Complications for Women)

Maternal morbidity encompasses physical and psychological conditions resulting from or aggravated by pregnancy that have an adverse effect on the woman’s health. Maternal morbidity ranges from mild to severe and can include complications and conditions associated with any pregnancy outcome. Extending maternal health surveillance to include identifying and reviewing pregnancy complications and factors associated with them has the potential to improve maternal health by providing information to influence the delivery of health services and health policy.

CDC researchers are currently focusing on severe morbidity because it has a greater effect on the woman’s health and poses greater risks to her immediate and lifelong well-being. It is important to identify women who experienced severe maternal morbidity, and review their care to develop prevention efforts.

Performing maternal health surveillance beyond mortality at the institutional, state, and national level, requires readily available information to identify women with severe morbidity during pregnancy. Recently, CDC researchers used a group of routinely collected ICD-9-CM discharge and procedure codes to identify significant complications of pregnancy. They found that the most severe complications of pregnancy were those that indicated hemorrhage requiring transfusion, hysterectomy, and seizures during delivery hospitalizations. Severe morbidity was more common at the extremes of reproductive age and for black women compared with white women. (Callaghan WM, MacKay AP, Berg CJ. Identification of Severe Maternal Morbidity during Delivery Hospitalizations, United States, 1991–2003. Am J Obstet Gynecol 2008; doi:10.1016/j.ajog.2007.12.020.)

Pregnancy-related Deaths

Maternal mortality in the United States declined markedly during the 20th century, but has declined little during the last 20 years. The earlier, historic decline was led largely by medical and technological advances.  In addition, interest and concern at the local, state, and federal levels led to developing systems for identifying, reviewing, and analyzing maternal deaths. These systems have determined causes of deaths, identified gaps in services, and disseminated findings and recommendations.

Although risks for pregnant women are low, some women have higher risks of death than others. Variability in the risk of death by race, ethnicity, and age indicates that more can be done to understand and reduce maternal deaths.

CDC scientists have conducted ongoing national surveillance of pregnancy-related mortality since 1987. The Pregnancy Mortality Surveillance System (PMSS) detects pregnancy-related deaths, analyzes factors associated with these deaths, and publishes information that may lead to state and national prevention strategies.

Strategies to Reduce Pregnancy-related Deaths
This manual describes strategies for conducting pregnancy-related or maternal mortality surveillance in the United States.

Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer (World Health Organization*)

Fact Sheet: Pregnancy-Related Mortality Surveillance—United States, 1991–1999

Maternal and Infant Health Data and Statistics
Provides data and statistics on a variety of reproductive health topics.

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Page last reviewed 11/25/08
Page last modified: 11/25/08
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion