Joan Adam, Secretary of Health
South Dakota Department of Health

Maternal mortality

Maternal mortality refers to the death of a women during pregnancy, childbirth or in the post-partum period.1 A mother’s death is tragic and can have lasting emotional, social, and economic consequences for her family and community.1-2 From the 2000 to 2014, the United States experienced a 26% increase in the maternal mortality rate.1 A combination of factors is responsible for this increase in the number of reported deaths. Improved reporting of maternal deaths is likely due to changes in death coding, computer data linkages, and the addition of a pregnancy checkbox to the death certificate in many states.3-4 Furthermore, a rise in chronic health conditions such as hypertension, diabetes, and chronic heart disease in pregnant women puts them at greater risk of pregnancy complications.4

Maternal Mortality Definitions:6

Tree graphic depicting relationship between pregnancy-associated, but not related death and pregnancy-related death.Pregnancy-associated death: The death of a woman while pregnant or within one year of the termination of pregnancy, regardless of the cause. This makes up the universe of maternal mortality. Within that universe are pregnancy-related deaths and pregnancy-associated, but not related deaths.

Pregnancy-associated, but not related death: The death of a woman during pregnancy or within one year of the end of pregnancy, from a cause that is not related to pregnancy.

Pregnancy-related death: The death of a woman during pregnancy or within one year of the end of pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

Pregnancy Mortality Surveillance System (PMSS)

The Pregnancy Mortality Surveillance System (PMSS) is a national surveillance system of pregnancy-related deaths started by the Center for Disease Control and Prevention (CDC) in 1986 to learn more about the clinical information surrounding maternal deaths.4

PMSS collects national data on all women who died during pregnancy or within 1 year of pregnancy. The data is summarized, and medically trained epidemiologists determine the cause and time of death related to the pregnancy. Along with being used in peer-reviewed literature and CDC publications, the PMSS data can be given back to states upon request.4

Pregnancy-Associated but not related vs pregnancy related deaths, 2010-2016 Chart.
2010 had 2 pregnancy-related and 6 pregnancy-associated deaths.
2011 had 3 pregnancy-related and 5 pregnancy-assiciated deaths.
2012 had 1 pregnancy-related and 6 pregnancy-assiciated deaths.
2013 had 1 pregnancy-related and 5 pregnancy-associated deaths.
2014 had 1 pregnancy-related and 4 pregnancy-associated deaths. 
2015 had 2 pregnancy-related and 4 pregnancy associated deaths. 2016 had 2 pregnancy-related deaths, and 5 pregnancy-associated but not related deathsPercent of Pregnancy-Associated but Not Related vs. Pregnancy Related Deaths, 2010-2016 chart.
74.5% Pregnancy-Associated but not related.
25.5% Pregnancy-Related.

Percent of Pregnancy-Associated Deaths Due to an Injury, 2010-2016. None 38.3%. Motor Vehicle Accident 21.3%. Suicide 14.9%. Drug Overdose (unintentional, accidental) 12.8%. Homicide 8.5%. Other 2.1%. Unknown 2.1%.Causes of Pregnancy-Associated Deaths, 2010-2016 graph.
Non-cardiovascular condition - 72.3%.
Cardiovascular conditions 10.6%.
Infection 4.3%. Hypertensive Disorders of Pregnancy 4.3%. Hemorrhage 2.1%. Amniotic Fluid Embolism 2.1%. Cerebrovascular accident 2.1%. Cardiomyopathy 2.1%.

South Dakota Vital Statistics

Demographic Characteristics of All Pregnancy-Associated Deaths, 2010-2019 chart.
Maternal Age less than 20 =11.3%, 20-24 = 12.7%, 25-29 = 31%, 30-34 = 25.4%, 35-39 = 14.1%, Greater than or equal to 40 = 5.6%.
Maternal Race - White = 52.1%, American Indian = 38%, Asian = 5.6%, black = 4.2%.
Marital Status - Married = 40.8%, Never Married = 47.9%, Divorced = 8.5%, Widowed = 1.4%, Unknown = 1.4%.
Education - Less than high school = 22.5%, High School Graduate = 40.8%, Some College = 12.7%, College Graduate or higher = 22.5%, Not stated = 1.4%.South Dakota also uses vital statistics data to examine the occurrence of maternal mortality in the state. The death certificates of women who died during pregnancy, childbirth, and one year postpartum are reviewed and linked to fetal birth and death certificates when possible. This data is more current than the PMSS data and includes deaths of South Dakota residents who died out of state. This results in slightly higher numbers of pregnancy-associated deaths than what is reported in the PMSS data.Number of Pregnancy Associated Deaths, 2010-2019.
2010 = 9.
2011 = 10.
2012 = 7.
2013 = 6.
2014 = 6. 
2015 = 6.
2016 = 6.
2017 = 6.
2018 = 9.
2019 = 6.

Timing of Pregnancy-Associated Deaths, 2010-2019 Chart. 29.6% Pregnant at time of death, 16.9% Pregnant within 42 days of death, 53.5% Pregnant 43 days to 1 year before death.



  1. MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues. Obstetrics and gynecology128(3), 447–455. doi:10.1097/AOG.0000000000001556

  2. Reed, H. E., Koblinsky, M. A., Mosley, W. H., Committee on Population, National Research Council. (2000). The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. Washington (DC): National Academies Press. Retrieved from

  3. Davis, N. L., Hoyert, D. L., Goodman, D. A., Hirai, A. H., & Callaghan, W. M. (2017). Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978-2012. American journal of obstetrics and gynecology217(3), 352.e1–352.e7. doi:10.1016/j.ajog.2017.04.042

  4. Centers for Disease Control and Prevention. (2018). Pregnancy Mortality Surveillance System. Retrieved from

  5. Centers for Disease Control and Prevention. (n.d.). Pregnancy Mortality Surveillance System Data. Unpublished data.

  6. Review to Action. (n.d.). Definitions. Retrieved from

  7. South Dakota Vital Statistics. (2017). Maternal mortality. Unpublished raw data.


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