Maternal Mortality Review Committee presents 2023 report showing decline in pregnancy-related deaths; mental health and hemorrhage identified as leading causes

The Idaho Maternal Mortality Review Committee (MMRC), an advisory committee to the Idaho Board of Medicine, presented its 2023 summary to the Senate Health and Welfare Committee and recommended continued investigation into access to evidence-based treatments for pregnant and postpartum women.

Oren Duffin, program director for the Health Professions Bureau and executive officer for the MMRC, told the committee that 13 cases were provided to the MMRC for investigation for calendar year 2023; 11 met the committee’s inclusion criteria for pregnancy-associated deaths. Of those 11, five were determined to be pregnancy-related and six were pregnancy-associated but not pregnancy-related. The MMRC found no evidence in the reviewed records that denial of care or medical error contributed to the 2023 deaths.

The committee reported that mental-health conditions and hemorrhage were the most common causes among the pregnancy-related deaths in 2023, each accounting for 40 percent of pregnancy-related deaths. The MMRC also calculated Idaho’s pregnancy-related mortality ratio at 22.6 deaths per 100,000 live births for 2023; using a federal methodology (MEC4) the ratio was 13.6 per 100,000 live births. By comparison, the HHS target rate is 15.7 deaths per 100,000 live births to be achieved by 2030, the MMRC presentation noted.

Duffin said 64 percent of 2023 maternal deaths were among women residing in urban areas and that 9 of the 11 mothers were insured at time of death. The MMRC noted that two of the decedents had illicit substances detected on autopsy. The committee also reported an apparent decline in pregnancy-associated deaths compared with prior years: a more than 31 percent decline compared to 2021 and a more than 44 percent decline for pregnancy-related deaths compared to 2021, though the MMRC said data for 2022 and 2024 were still under review and subject to change.

The MMRC made several recommendations, including that the legislature and health systems investigate access to evidence-based treatments for pregnant and postpartum women — including for those who are incarcerated — and increase awareness and access to substance-use-disorder treatments and telehealth for rural patients. The MMRC directed certain recommendations to hospitals and providers around complications such as sepsis, preeclampsia and hemorrhage.

Committee members asked detailed questions about committee composition, case classification, and specific cases. Senator Wintrow requested clarification about committee recruitment and clinical qualifications; Duffin described a recruitment notice and said members were screened for education, training and practice experience and that the member list is available in the report. On a specific case involving hemorrhage after a dilation and curettage (D&C) procedure, Duffin said he is not a physician and offered to have a clinician from the MMRC follow up with Senator Wintrow to explain clinical details. Duffin said the report did not identify delay in care or deviation from standard of care in that case.