Maternal Mortality Review Committee reports decline in pregnancy-related deaths in 2023, cites mental health and hemorrhage as leading causes

Oren Duffin, program director for the Health Professions Bureau and executive officer for Idaho's Maternal Mortality Review Committee, presented the MMRC's 2023 report to the Senate Health and Welfare Committee, summarizing case reviews and recommendations.

Duffin said 13 cases were provided to the MMRC for investigation and 11 met the committee's inclusion criteria for pregnancy-associated deaths (death while pregnant or within one year of pregnancy). Of those 11 cases, 5 were determined to be pregnancy-related and 6 were pregnancy-associated but not pregnancy-related. The committee concluded there was no evidence in the records reviewed that medical error or denial of care contributed to the 2023 deaths, and it reported no direct evidence in the cases of discrimination.

The report includes several demographic and cause-of-death findings: 64 percent of the deaths occurred in women residing in urban areas and 36 percent in rural/frontier counties; 9 of 11 women were insured at the time of death; 2 of 11 (18 percent) had illicit substances present on autopsy; and 64 percent of the women had educational attainment at the level of high-school diploma, GED or some college. Idaho's pregnancy-related mortality ratio declined from 40.1 deaths per 100,000 live births in 2021 to 22.6 in 2023. Using a constrained federal methodology (MEC4), the 2023 pregnancy-related mortality ratio was 13.6 per 100,000 live births, below the HHS goal of 15.7 by 2030.

Mental health conditions and hemorrhage were the most common causes among pregnancy-related deaths in 2023, each accounting for 40 percent of the pregnancy-related deaths the committee reviewed. Duffin said one pregnancy-related death resulted from a woman not seeking medical care during the pregnancy or postpartum period.

The MMRC made recommendations targeted at specific audiences. The single recommendation directed to the Idaho Legislature asks the legislature to consider investigating access to evidence-based treatments, including pharmacologic treatment for substance use disorder, for pregnant and postpartum women, including those who are incarcerated. Other recommendations include encouraging telehealth to improve access in rural areas and increasing awareness of and access to substance use disorder treatment and clinical recognition of complications such as sepsis, preeclampsia and hemorrhage.

Committee members asked about committee composition, case classification and whether any deaths were linked to restricted medical care. Duffin described outreach and recruitment to professional associations, screening and review by the Board of Medicine, and said committee membership includes OB-GYNs, maternal-fetal medicine specialists, family physicians and rural practitioners. In response to questions about classification of suicides, Duffin explained the committee separated pregnancy-associated versus pregnancy-related classifications and noted the distinction affects later analytic tables. Senator Wintrow requested follow-up from a clinician on a specific case involving hemorrhage after a dilation and curettage procedure; Duffin offered to arrange clinician follow-up and written clarification.

Ending: The MMRC will continue reviewing additional calendar years (noted work planned for 2022 and 2024 cases) and the committee provided recommendations intended to improve access and clinical recognition of pregnancy complications and substance use disorder care for pregnant and postpartum women.