Maternal Mortality Review Committee reports decline in pregnancy-related deaths for 2023; mental health and hemorrhage most common 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 to the Senate Health and Welfare Committee.

"For calendar year 2023, 13 cases were provided to the MMRC for investigation. Eleven of the 13 met criteria for inclusion," Duffin said. Of the 11 pregnancy-associated deaths reviewed, the committee determined five were pregnancy-related and six were pregnancy-associated but not pregnancy-related.

The committee reported 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), Idaho's pregnancy-related mortality ratio for 2023 was 13.6 deaths per 100,000 live births; the federal HHS goal for the United States is 15.7 deaths per 100,000 by 2030, the report said.

Mental-health conditions and hemorrhage were the most common causes of pregnancy-related deaths in the 2023 review, each accounting for 40 percent of pregnancy-related deaths. The MMRC also reported that medical error or denial of care was not identified as a contributing factor in the 2023 deaths reviewed and that there was no direct evidence in the reviewed records that the deaths were attributable to discrimination.

The committee outlined recommendations for multiple audiences. The only recommendation directed to the Idaho Legislature notes the committee's interest in examining current access to care for pregnant and postpartum women, including incarcerated women, and access to evidence-based treatments such as pharmacologic agents for substance use disorder. Other recommendations encourage increased telehealth access for rural populations and greater awareness of substance use disorder treatment options and obstetric complications such as sepsis, preeclampsia and hemorrhage among hospitals and providers.

Committee members asked detailed questions about committee composition and methodology. Senator Wintrow asked how committee members were recruited and whether physicians who participated in previous MMRCs were included; Duffin said members were screened and selected by the division and reviewed by the Idaho Board of Medicine based on education, training and practice experience. He said the names and practice settings of members are publicly available in the report.

Senators also asked about specific cases in the report. Duffin said one pregnancy-related death involved a woman who did not seek medical care during the peripartum period and that, for the cases reviewed, the committee did not find evidence of a delay in care or deviation from standards that would have been called out in the report.

Duffin said the MMRC will continue its work and is scheduled to review 2022 and 2024 data in 2025. He said the committee's work is data driven and that future reports will continue to identify trends and targeted recommendations.