By Chris Adams

The United States is one of the richest countries in the world, with some of the most advanced medical technology.

It also has a dismal – and worsening – record on maternal health care. Bottom line: Pregnancy is killing many women, and there are steps that could be taken to reduce maternal deaths.

That was the message of Dr. Nandita Scott, co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital and Harvard Medical School, who led National Press Foundation fellows through the latest statistics on maternal health.

“The United States has the worst maternal mortality in the developed world,” she said. “And the awareness of that is very low.”

Scott (bio, Twitter) and Dr. Malissa Wood (bio, Twitter) – also a co-director of the women’s heart program – noted that maternal mortality has doubled in the United States over the last 30 years, even as it has declined in other countries. Cardiac conditions are one of the main causes.

Mortality varies greatly by demographic group, with African American women dying during childbirth at a rate triple that of whites (43 per 100,000 live births, compared with 13).

The reasons are many, and different for different groups. Among some groups, it’s that women are older, with more chronic conditions and a greater reliance on fertility therapies. For other groups, it’s a lack of access to primary care, wide variations in quality of care, and a lack of national protocols and standards of care.

Wood detailed another factor that affects women and their hearts: stress. It’s a risk factor for heart disease, and psychosocial risk factors affect women more than men.

“All we need to do is look at the diseases of despair to see that stress is rampant,” said Wood, who is also the author of “Smart at Heart” and “Thinfluence.” “Stress and poor sleep are significant predictors of cardiovascular risk.” She said only 7% of Americans meet the ideal standards for cardiovascular health.