State—s maternal mortality review shows decline in 2023; mental health and hemorrhage top pregnancy-related causes

The Maternal Mortality Review Committee (MMRC), an advisory body to the Idaho Board of Medicine, presented its 2023 summary report to the Senate Health and Welfare Committee and described a decline in pregnancy-associated mortality compared with 2021.

Oren Duffin, program director for the Health Professions Bureau and executive officer for the MMRC, said the bureau and committee reviewed 13 cases reported to the MMRC for calendar year 2023 and determined 11 met the committee's inclusion criteria (death of a woman while pregnant or within one year of pregnancy). Of those 11 pregnancy-associated deaths, five were determined to be pregnancy-related and six were pregnancy-associated but not pregnancy-related.

"For calendar year 2023, 11 of 13 met criteria for inclusion committee review," Duffin said. "Five were determined to be pregnancy related, with the remaining six categorized as pregnancy associated but not pregnancy related."

The MMRC reported that 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, the state had a pregnancy-related mortality ratio of 13.6 deaths per 100,000 live births; the HHS target rate cited by the committee is 15.7 deaths per 100,000 live births by 2030.

Mental-health conditions and hemorrhage were the most common causes among pregnancy-related deaths in 2023, the committee said, each accounting for 40 percent of pregnancy-related deaths. The MMRC found no evidence in reviewed records that medical error or denial of care contributed to the 2023 deaths, and it reported no direct evidence that any 2023 deaths were attributable to discrimination.

Duffin described the committee's process: vital-statistics data are collected by Health and Welfare, records are requested and de-identified, and the committee answers standardized questions about each case, including whether the death was pregnancy-related and whether it was preventable. The MMRC offered several recommendations, including encouraging telehealth access in rural areas, increasing awareness and access to evidence-based substance-use disorder treatment for pregnant and postpartum women, and directing further investigation of access to care for incarcerated pregnant and postpartum women.

Committee members asked about the committee's membership, recruitment and whether physicians who previously served were on the panel; Duffin said members were screened for education and practice experience and reviewed by the Board of Medicine. Members also asked for more medical detail on a case involving post-procedure hemorrhage and whether delay or deviation from standard of care occurred; Duffin said no evidence of delay or deviation was found in the records reviewed and offered to arrange follow-up by a clinician on the committee.

The MMRC noted that 2023 represents a decline in pregnancy-associated and pregnancy-related deaths compared with 2021, but it said work remains and additional report cycles (including reviews of 2022 and 2024 cases) were scheduled.

Votes and next steps: The presentation was informational. The MMRC urged continued attention to mental-health services, hemorrhage screening and substance-use disorder treatment access for pregnant and postpartum women and recommended further study of care access for incarcerated pregnant women.