Maternal Mortality Review Committee reports decline in pregnancy-related deaths in 2023, flags mental health and hemorrhage

Oren Duffin, executive officer for Idaho’s Maternal Mortality Review Committee (MMRC), presented the MMRC’s 2023 report to the Senate Health and Welfare Committee and described the committee’s findings and recommendations.

Duffin said 13 maternal death cases were provided to the MMRC for investigation; 11 met the committee’s inclusion criteria (death while pregnant or within one year of pregnancy). Of those 11 pregnancy-associated deaths, the committee determined five were pregnancy related and six were pregnancy associated but not pregnancy related. The MMRC concluded medical error or denial of care was not identified as a contributing factor in the 2023 deaths it reviewed.

The report found mental-health conditions and hemorrhage were the most common causes among the five pregnancy-related deaths, accounting for 40 percent each of those cases. One of the pregnancy-related deaths involved a woman who did not seek medical care during the pregnancy or postpartum period. The committee also reported that 64 percent of the maternal deaths occurred among women residing in urban areas and 36 percent among those in rural or frontier counties. Nine of the 11 women were insured at the time of death; two had illicit substances identified on autopsy.

Duffin provided trend context: Idaho’s pregnancy-related mortality ratio fell from 40.1 deaths per 100,000 live births in 2021 to 22.6 in 2023. Using a constrained federal methodology (MEC4), Idaho’s ratio was 13.6 deaths per 100,000 live births, compared with the HHS goal of 15.7 per 100,000 by 2030.

The MMRC’s recommendations include: investigating access to care for pregnant and postpartum women (including incarcerated women) and evidence-based treatments for substance use disorder; encouraging telehealth to improve access in rural areas; and increasing awareness of treatments and complication recognition for conditions such as sepsis, preeclampsia and hemorrhage. The committee directed one recommendation to the legislature to study access to evidence-based SUD treatment for pregnant and postpartum women.

Senators asked for more detail about committee membership, recruitment and case classification; Duffin described the recruitment and screening process, said members were selected based on education, training and practice experience, and pointed to the public list of members in the report. Senator Wintrow asked follow-up clinical questions about a death associated with hemorrhage following what was described in the report as a D&C procedure; Duffin said he is not a physician and offered to arrange follow-up with a committee clinician to review that case in more detail. Senator Blaylock and other members asked how Idaho’s ratios compare with other states and Duffin explained differences in methodology and the impact of small numbers on year-to-year swings.

Duffin said the MMRC will continue reviewing prior and subsequent years and will provide additional reports; the committee plans to review calendar-year 2022 and 2024 cases in 2025 and update figures as required by vital statistics.