Maternal Mortality Review Committee presents 2023 report: Idaho pregnancy-related deaths declined, mental health and hemorrhage leading causes

Oren Duffin, program director for the Health Professions Bureau and executive officer for the Maternal Mortality Review Committee (MMRC), presented the MMRC's 2023 report to the Senate Health and Welfare Committee on Jan. 29.

Duffin said the committee received 13 cases for investigation in calendar year 2023; 11 met the inclusion criterion (death of a woman while pregnant or within one year of pregnancy). Of those 11 pregnancy-associated deaths, the MMRC determined 5 were pregnancy-related and 6 were pregnancy-associated but not pregnancy-related. The committee found no evidence in the records it reviewed that medical error or denial of care contributed to the 2023 deaths, Duffin said.

Key statistics presented in the report included that 64% of the 2023 maternal deaths occurred among women residing in urban areas and 36% in rural or frontier counties; 9 of the 11 mothers were insured at the time of death. Two (18%) of women had illicit substances detected at autopsy. 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 federal MEC4 methodology, Idaho's pregnancy-related mortality ratio was 13.6 per 100,000 live births for the period analyzed, below the HHS goal rate cited in the presentation of 15.7 per 100,000 (goal to be achieved by 2030).

Duffin reported that mental-health conditions and hemorrhage were the most common causes among the pregnancy-related deaths in 2023 (each accounting for 40% of pregnancy-related deaths in the year). He also noted one pregnancy-related death occurred when the woman did not seek medical care during the pregnancy or postpartum period.

The MMRC's report includes recommendations directed to different audiences. The only recommendation singled out for the Idaho Legislature in the 2023 report was that the committee consider investigating current access to evidence-based treatments for pregnant and postpartum women, including incarcerated individuals, and pharmacologic treatments for substance use disorder. Other recommendations urge increased telehealth access for rural and frontier populations, awareness of substance use disorder treatments for pregnant and postpartum women, and provider-focused attention to complications such as sepsis, preeclampsia and hemorrhage.

Committee members asked questions about committee composition and process, case classification, and whether any deaths involved denial of care. Senator Shippey asked whether any deaths were linked to legal restrictions on care; Duffin said the committee found no evidence of denial or refusal of care in the records reviewed. Senator Wintrow asked about committee recruitment, membership qualifications and requested further clinical detail on a hemorrhage case that appeared linked to a dilation and curettage (D&C) procedure; Duffin said he would arrange for a clinician on the committee to follow up with detailed clinical explanation. Senator Blaylock asked about national comparisons and whether swings in small numbers are typical; Duffin cautioned that small absolute numbers can produce large swings in ratios and provided examples of neighboring states' reported ratios.

Duffin said the MMRC will continue reviewing prior years (2022 and 2024) and will provide further reports; the committee recommended several actions to improve maternal health surveillance and treatment access.