Andrea P. MacKay, MSPH, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), 3311 Toledo Rd., Rm 6121, Hyattsville, MD 20782, 301 458-4358, anm3@cdc.gov, Cynthia Berg, MD, MPH, Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Mailstop K23 Koger Bldg, Atlanta, GA 30333, and Jeffrey C. King, MD, Department of Obstetrics and Gynecology, St. Vincent Hospital Manhattan, 170 West 12th Street, Coleman 903, New York, NY 10011.

Multiple births have increased dramatically since 1980, due in part to trends in older age at childbearing and increased use of fertility enhancing therapies. Multiple gestation pregnancies have a disproportionate share of adverse pregnancy outcomes, including maternal morbidity and mortality. Our objective was to evaluate trends in multiple gestation pregnancy deaths, and to determine risk factors associated with these deaths. We used information from CDC’s National Center for Chronic Disease Prevention and Health Promotion’s Pregnancy Mortality Surveillance System, which conducts epidemiologic surveillance of pregnancy-related deaths. For 1980-1997, we calculated pregnancy-related gestation-specific mortality ratios, based on the number of pregnancies with live birth outcomes, for all pregnancy-related deaths with a live birth or fetal death outcome. We compared singleton outcomes with multiples to examine the risk per 100,000 pregnancies. Race, age, education, and cause of death were also evaluated. Between 1980 and 1997, there were 164 pregnancy-related deaths among women with multiple gestations and 3,675 deaths among singleton pregnancies. Using pregnancies as the denominator, the pregnancy mortality ratio for singletons increased from 4.0/100,000 pregnancies to 7.9 during the 18 year study period; for multiples the ratio increased from 11.4/100,000 pregnancies to 36.6, with a relative risk that increased from 2.9 to 4.6. Among women age 35 and older with multiple gestations, the relative risk of pregnancy-related death was 2.4 for 1990-97 compared with 1980-89. This first national analysis of deaths among multiple gestation pregnancies suggests a substantially higher risk of maternal death compared to singleton pregnancies.

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