Maternal and Child Health Journal

, Volume 19, Issue 4, pp 733–738 | Cite as

Ectopic Pregnancy Among American Indian and Alaska Native Women, 2002–2009

  • Lori de RavelloEmail author
  • Arianne Folkema
  • Scott Tulloch
  • Melanie Taylor
  • Brigg Reilley
  • Karen Hoover
  • Robert Holman
  • Andreea Creanga


To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15–44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002–2009. We used 2002–2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15–44 years receiving care at IHS-affiliated facilities during 2002–2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15–19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35–39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1–2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002–2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.


Ectopic pregnancy North American Indians 



The authors would like to thank Thomas A. Peterman, MD, MS (CDC, Atlanta, GA); Catherine L. Satterwhite, PhD, MSPH, MPH (University of Kansas School of Medicine, Wichita, KS); Jean Howe, MD, MPH (IHS, Shiprock, NM); and Suzanne Zane, DVM (CDC, Portland, OR) for their insightful review and expertise as this manuscript developed. We thank Barbara Strzelczyk (IHS), Diana Roberts (CDC), and Jason Mehal, MPH (CDC) for technical assistance, as well as the staff of the IHS National Patient Reporting System and the staff at the participating IHS, tribal, and urban Indian health care facilities.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Lori de Ravello
    • 1
    Email author
  • Arianne Folkema
    • 2
  • Scott Tulloch
    • 3
  • Melanie Taylor
    • 4
  • Brigg Reilley
    • 5
  • Karen Hoover
    • 3
  • Robert Holman
    • 2
  • Andreea Creanga
    • 1
  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionPhoenixUSA
  5. 5.HIV/AIDS Prevention Program, Division of Epidemiology and Disease PreventionIndian Health ServiceAlbuquerqueUSA

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