Talking Points Maternal Mortality in Missouri October 13, 2017

Maternal Mortality in Missouri

1. Maternal mortality / pregnancy related mortality rate is an estimate of the number of
pregnancy-related deaths for every 100,000 live births. Any discussion about maternal
mortality rates and associated comparisons must pay attention to the definition that is
being used for the comparison. Currently there are two definitions that are widely in use:

a. Definition # 1. Maternal death is the death of a woman while pregnant or within 42

days of termination of pregnancy, irrespective of the duration and site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its management but not
from accidental or incidental causes (used by World Health Organization, WHO and
MCH Block Grant). A vast majority of newspaper reports / articles discussing maternal
deaths are also based data derived from this definition.
b. Definition # 2. Maternal death or a pregnancy-related death is defined as the death of a
woman while pregnant or within 1 year of pregnancy terminationregardless of the
duration or site of the pregnancyfrom any cause related to or aggravated by the
pregnancy or its management, but not from accidental or incidental causes. (Used by
ACOG / CDC and Missouri Vital Statistics).

2. Data derived from either definition clearly indicates that maternal deaths in Missouri have
steadily increased over the past decade and Missouris maternal mortality rate is
significantly higher than national rates. Americas Health Ranking Report Missouri ranked
42nd in the nation for high maternal mortality while pregnant or within 42 days of
termination of pregnancy (Definition # 1).

3. In 2016, the maternal mortality rate in Missouri is 35 maternal deaths per 100,000 live
births while pregnant or within 1 year of pregnancy termination (Definition # 2). The
Healthy People 2020 objective is 11.4 maternal deaths / 100,000 live births
Talking Points Maternal Mortality in Missouri October 13, 2017

However, maternal mortality is considered a rare event and because of the relatively small
number of maternal deaths, computation of rates on an annual basis is subject to high degree
of variability and hence forth three year moving averages are a better reflection of the data.

4. A steady increase in maternal deaths has been observed over the past couple of years,
particularly since 2010. The reasons for the overall increase in pregnancy-related mortality
are unclear. The use of computerized data linkages by the states, changes in the way causes
of death are coded, and the addition of a pregnancy checkbox to the death certificate in
many states have likely improved identification of pregnancy-related deaths over time.
Whether the actual risk of a woman dying from pregnancy-related causes has increased is
unclear. Missouri implemented the new birth / death certificate beginning in 2010.
5. Many studies show that an increasing number of pregnant women in the United States
have chronic health conditions such as hypertension, diabetes, and chronic heart disease.
These conditions may put a pregnant woman at higher risk of pregnancy complications.
Although the overall risk of dying from pregnancy complications is low, some women are
at a higher risk than others. Similar to national observations and from other states,
African-American women are at an increased risk of maternal death compared to white
women. They are 2.5 times (65.4 vs 26.2) more likely to experience a maternal death than
white women (slide # 2).
6. The leading causes of maternal deaths in Missouri are embolism, cardiovascular conditions
and hemorrhage. A significant of cases is also listed under other because of lack of
Talking Points Maternal Mortality in Missouri October 13, 2017

information on the death certificate / prenatal records and other medical records thus
resulting in that case being categorized as Other.
7. What is Missouri doing to reduce maternal deaths?
a. Initiated the Pregnancy Associated Mortality Review (PAMR) project in 2011. As
part of the PAMR project, an in depth review of maternal deaths (including medical
records, CME reports etc.) is conducted by the PAMR committee to identify
underlying issues causing maternal deaths and identify system gaps / enhancements
that could prevent maternal deaths. The ten year aggregate report was the first step
in Missouri to review and assess the status of maternal mortality in the state.
b. The Missouri PAMR project is currently in the process of abstracting data for
maternal deaths during the 2009 -2012 time period and is in the process of catching
up with more recent years of data.
c. Participated in the AMCHP Every Mother Initiative (EMI) grant. As part of the this
grant, beginning with 2009 maternal deaths, Missouri started entering data into the
CDC developed software application system MMRDS. Enhancements to this
system are currently in progress. Upon successful completion of data entry for a
case into this system, it will assess preventability.