Original Research Maternal Cardiovascular Mortality in Illinois, 2002–2011 Joan Briller, MD, Abigail R. Koch, MA, and Stacie E. Geller, PhD, for the Illinois Department of Public Health Maternal Mortality Review Committee Working Group OBJECTIVE: To describe the demographic characteristics of women in Illinois who died from cardiovascular disease during pregnancy or up until 1 year postpartum, addressing specific etiologies, timing of death, propor- tion of potentially preventable mortality, and factors associated with preventability. METHODS: This is a retrospective analysis from the Illinois Department of Public Health Maternal Mortality Review process using International Classification of Diseases, 9th Revision codes that attributed cardiovas- cular disease as the immediate or underlying cause of maternal death in Illinois from 2002 to 2011. We categorized the etiology of cardiovascular mortality, analyzed demographic factors associated with cardiovas- cular mortality in comparison with noncardiovascular causes, defined the relationship to pregnancy, and identified factors associated with preventability. RESULTS: There were 636 deaths in Illinois from 2002 to 2011 of pregnant women or within 1 year postpartum. One hundred forty women (22.2%) died of cardiovas- cular causes, for a cardiovascular mortality rate of 8.2 (95% confidence interval 6.9–9.6) per 100,000 live births. Women with cardiovascular mortality were likely to be older and die postpartum. The most common etiologies were related to acquired cardiovascular disease (97.1%) as compared with congenital heart disease (2.9%). Cardiomyopathy was the most common etiology (n539 [27.9%]), followed by stroke (n532 [22.9%]), hypertensive disorders (n518 [12.9%]), arrhythmias (n515 [10.7%]), and coronary disease (n513 [9.3%]). Nearly 75% of cardiac deaths were related to pregnancy as compared with 35.3% of noncardiac deaths. More than one fourth of cardiac deaths (28.1%) were poten- tially preventable, attributable primarily to health care provider and patient factors. CONCLUSION: From 2002 to 2011, more than one fifth of maternal deaths in Illinois were attributed to cardio- vascular disease such as cardiomyopathy. More than one fourth of these deaths were potentially preventable. Health care provider and patient factors were identified, which may be modifiable through education and inten- sive postpartum monitoring, which may diminish mor- tality. State maternal mortality reviews can identify opportunities for reducing maternal deaths. (Obstet Gynecol 2017;129:819–26) DOI: 10.1097/AOG.0000000000001981 O ver the past 25 years, pregnancy-related mortal- ity has doubled in the United States. 1 Cardio- vascular disease has emerged as a leading and increasing cause of maternal mortality in the United States and globally. 2–5 Until recently, two of the most common causes of maternal mortality were hemor- rhagic and embolic disease (pulmonary and amniotic fluid embolism). 4 However, improvements in diagno- sis and management of these conditions, especially hemorrhagic complications, have resulted in signifi- cant decreases in associated mortality. Despite this, maternal mortality has risen. Cardiovascular disease, therefore, remains a leading contributor to U.S. maternal mortality that needs to be addressed. 1,4,5 The physiologic requirements of pregnancy chal- lenge women with both known and undiagnosed cardiac disease. Cardiac disease in pregnancy can present as heart failure, arrhythmias or sudden death, and ischemia. Pre-existing cardiac disease can be the result of congenital heart disease, valvular heart disease, hypertensive heart disease, or coronary artery From the Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois. Each author has indicated that he or she has met the journal’s requirements for authorship. Corresponding author: Joan Briller, MD, Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood Street (mc 715), Chicago, IL 60612; email: briller@uic.edu. Financial Disclosure The authors did not report any potential conflicts of interest. © 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/17 VOL. 129, NO. 5, MAY 2017 OBSTETRICS & GYNECOLOGY 819 Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.