Merck brings maternity program from poor nations to U.S. as deaths rise


By Sharon Begley

NEW YORK, Nov 19 (Reuters) - Merck & Co on Tuesdaysaid it is expanding its "Merck for Mothers" program, which aimsto reduce pregnancy-related deaths from impoverished countriessuch as Senegal and Zambia, to the United States - a starkreminder of how far the country lags other wealthy nations onkey measures of health.

"As Americans, we simply should not accept that 46 countrieshave lower rates" of reported maternal mortality, said MerckChief Executive Ken Frazier. The fact that U.S.pregnancy-related deaths have nearly doubled since 1990 is"appalling" and "something we ought to be ashamed of," he said.

"Given how sophisticated medical care is in this country, Ithink most Americans would be astonished" that almost 900 womendie each year as a result of pregnancy or childbirth and 50,000have close calls, Frazier said.

The U.S. drugmaker launched the $500 million global programin 2011 to reduce pregnancy-related deaths, focusing on India,Uganda and other poor countries with only rudimentary healthcaresystems.

However, pregnancy-related deaths in the United States haverisen from 7.2 per 100,000 live births in 1987 to 17.8 per100,000 in 2009 (the latest year with reliable data), accordingto the U.S. Centers for Disease Control and Prevention. The rateamong African-American women is more than triple that of whitewomen: 35.6 versus 11.7 deaths per 100,000 live births.

The deaths include any that occur while a woman is pregnantor within a year after she gives birth, from any cause relatedto or aggravated by pregnancy.

The leading maternal killers include cardiovascular disease,venous thromboembolism, hemorrhage, hypertension and sepsis,said Dr Mary D'Alton of Columbia University Medical Center inNew York City, a specialist in high-risk maternal and fetalmedicine.

According to a study presented on Sunday at a meeting of theAmerican Heart Association, heart disease is the leading causeof pregnancy-related deaths in California. "Women who give birthare usually young and in good health," said Dr Afshan Hameed ofthe University of California, Irvine, who led the research. "Soheart disease shouldn't be the leading cause ofpregnancy-related deaths, but it is."

The reasons for the rise in maternal mortality are unclear.Better reporting is part of it: some states only recently addeda "pregnancy" check box to death certificates, said Dr EdwardMcCabe, medical director of the March of Dimes.

"We're getting better data, yes, but what these data aretelling us is that we have an unacceptably high rate ofpregnancy-related mortality."

Another likely reason for the increase is the risingprevalence of chronic diseases. Diabetes, chronic heart diseaseand hypertension - which can occur as a result of obesity - havebecome more common in women of reproductive age. And forunexplained reasons, the 2009 H1N1 (swine flu) pandemic killedmany pregnant women in the United States: although pregnantwomen account for about 1 percent of the U.S. population, theymade up 5 percent of the deaths, the CDC reported.

"Merck for Mothers" will provide $6 million to U.S. programsin 10 states and three cities aimed at decreasing the number ofwomen who die as a result of being pregnant or giving birth.Local programs include Baltimore Healthy Start, which works withneighborhood clinics to improve prenatal and primary care forpregnant women who have high-blood pressure, diabetes and otherchronic conditions, and the Maternity Care Coalition inPhiladelphia, whose "Safe Start MOMobile" sends health advocatesinto the homes of high-risk pregnant women.

The program will also work through the American Congress ofObstetricians and Gynecologists to develop standardizedprotocols for treating the leading causes of maternal death,said Columbia's D'Alton. Currently, there is significantvariation in how obstetricians and hospitals treatpotentially-fatal obstetric emergencies such as postpartumhemorrhaging and embolisms.

"There are no national guidelines about what to do in theevent of a maternal emergency," D'Alton said. "Variability isthe enemy of safety."

Merck is collaborating with the London School of Hygiene &Tropical Medicine to assess whether its maternity programs in Uganda, Zambia and other countries are making a difference, andwill publish data on what works and what doesn't.

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