What factor is most associated with an increased risk of maternal mortality during pregnancy?

The association between pre-existing medical conditions, particularly cardiovascular disease, and maternal mortality during pregnancy is well established. Such conditions can significantly complicate pregnancy and increase the risk of life-threatening complications. Cardiovascular diseases can affect the hemodynamic adaptations that are necessary during pregnancy, heightening the risk of events such as heart failure, arrhythmias, and stroke. Moreover, pregnant individuals with pre-existing medical conditions may face challenges in managing these issues in the context of the physiological changes that occur during pregnancy, which can further increase the likelihood of severe complications.

Other factors, such as obesity, advanced maternal age, and low socioeconomic status, can also contribute to increased risks during pregnancy. However, they are often considered in the context of how they may interact with pre-existing medical conditions. For example, obesity can lead to gestational diabetes and hypertension, while advanced maternal age is associated with chromosomal abnormalities and pregnancy complications. Nonetheless, cardiovascular disease remains one of the most critical contributors to maternal mortality due to its direct impact on vital organ systems during the stress of pregnancy.