Each year, approximately 1,800 women die in the U.S. during or within a year of pregnancy. Of these pregnancy-associated deaths almost 700 are pregnancy-related, from a cause related to or aggravated by the pregnancy or its management. A racial disparity persists among pregnancy- related deaths with a pregnancy-related mortality rate or ratio of 40.0 deaths per 100,000 live births among non-Hispanic Black women compared to a rate of 12.4 among non-Hispanic white women. Maryland has reviewed pregnancy-associated and pregnancy-related deaths among State residents since 2000 when the Maryland Maternal Mortality Review Program was established in statute. Maryland has an average of 38 pregnancy-associated deaths per year. Since 2010, pregnancy-related deaths have decreased substantially in the State but racial disparities persist with non-Hispanic Black women 2.7 times more likely to die than non-Hispanic white women.
The purpose of the proposed project is to improve the identification and characterization of these deaths to better understand the factors underlying racial disparities and to inform prevention efforts. This improved surveillance will involve the identification of pregnancy-associated and pregnancy-related deaths; abstraction of clinical and non-clinical data into a standard data system; conducting multidisciplinary reviews; and entering committee decisions into the standard data system. Quality assurance processes developed under this initiative will improve data quality and timeliness, in partnership with the CDC (Centers for Disease Control and Prevention). Analysis of the enhanced surveillance data will enable dissemination of findings to inform prevention strategies that reduce maternal deaths.
Specific activities will include maintaining a multidisciplinary review committee that includes both clinical and non-clinical disciplines and organizations; identifying pregnancy-associated deaths on a routine basis no later than 1 year from the date of death; and abstracting and entering information about all deaths in the Maternal Mortality Review Information Application (MMRIA) in preparation for committee review no later than 2 years from the date of death. Maryland’s efforts will also ensure that all deaths potentially related to pregnancy are reviewed within 2 years of the date of death; committee decisions including recommendations are documented in MMRIA within 30 days of completing the review of the death. Data quality assurance checks will be performed for completeness within 90 days of completing review and MMRIA data will be analyzed to provide information on burden, causes and distribution of deaths, and opportunities for prevention. Other activities will include providing obstetric emergency simulation training and unconscious bias training for health care practitioners, the implementation of family interviews, an annual Maternal Mortality Summit, and the development and dissemination of topic briefs, provider alerts and an annual report based on findings from the improved surveillance efforts.
The anticipated results of these efforts will include more timely, accurate and standardized information about pregnancy-associated deaths; increased awareness of maternal mortality in Maryland and the recommendations of Maryland’s Maternal Mortality Review Committee, and the implementation of data driven recommendations. Proposed long-term outcomes include the elimination of preventable maternal deaths, reduction in maternal complications of pregnancy, reductions in disparities in maternal deaths and complications of pregnancy, and improvement in the health of reproductive age women.