Maternal Mortality Review Committee reports drop in pregnancy-related deaths in 2023; mental-health and hemorrhage cited as leading causes

Oren Duffin, program director for the Health Professions Bureau and executive officer for Idaho’s Maternal Mortality Review Committee (MMRC), presented the MMRC’s 2023 report and summary to the Senate Health and Welfare Committee.

Duffin said the MMRC received 13 maternal-death cases for preliminary review in 2023; 11 met the committee’s inclusion criteria (death of a woman while pregnant or within one year of pregnancy). Of the 11 pregnancy-associated deaths the MMRC reviewed, five were determined to be pregnancy-related and six were pregnancy-associated but not pregnancy-related. The committee determined that medical error or denial of care did not contribute to the reviewed 2023 deaths, and it found no direct evidence in the reviewed records of discrimination contributing to those deaths.

Key findings Duffin cited from the report:

- Idaho’s pregnancy-related mortality ratio decreased from 40.1 deaths per 100,000 live births in 2021 to 22.6 in 2023. - Using a constrained federal methodology (the MME or related HHS method cited in the report), Idaho’s pregnancy-related mortality ratio was 13.6 deaths per 100,000 live births for 2023, below the HHS target of 15.7 per 100,000 by 2030. - Mental-health conditions and hemorrhage each accounted for 40 percent of pregnancy-related deaths in 2023. - One of the five pregnancy-related deaths occurred in a woman who did not seek medical care during the pregnancy period covered by the committee.

Duffin described committee procedures: the Bureau of Vital Statistics supplies suspected maternal deaths to the MMRC, the MMRC requests records, abstracts and de-identifies cases, and committee members — selected for clinical expertise and practice experience — discuss cases using a standardized case-review instrument.

Committee members asked about member recruitment and clinical composition; Duffin said the MMRC roster was publicly posted and that members were screened and selected by division staff and reviewed by the Idaho Board of Medicine. He said the committee includes clinicians such as obstetrician–gynecologists, maternal–fetal medicine specialists and rural primary-care physicians drawn from across the state.

Senators questioned details of specific cases — including classification of suicides and a pregnancy-related hemorrhage that involved a dilation and curettage procedure (D&C) — and requested a physician on the MMRC to provide more clinical context to the committee. Duffin offered to arrange follow-up conversations with committee clinicians to address technical questions.

The MMRC report recommended that legislators investigate access to evidence-based treatment for pregnant and postpartum women, including pharmacologic treatment for substance-use disorder; it also urged increased awareness and access to telehealth for rural patients and improved recognition of sepsis, preeclampsia and hemorrhage among health-care providers. The MMRC will continue reviewing 2022 and 2024 data as part of future reports, Duffin said.

The committee did not take an action vote on the MMRC report; senators asked follow-up questions and requested additional clinical input for some cases.