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State Maternal Mortality Review: overdose, mental health and postpartum care drive most pregnancy-related deaths
Summary
New Hampshire's Maternal Mortality Review Committee reported five pregnancy-associated deaths in 2023, with substance use disorder and mental-health conditions major contributors. The committee called for expanded postpartum Medicaid coverage and targeted clinical education.
State public-health officials and the Maternal Mortality Review Committee (MMRC) presented a report to the oversight committee describing maternal deaths in New Hampshire and recommendations to reduce preventable deaths.
"In the calendar year 2023, we had 5 pregnant associated deaths," Caroline Yamasege, maternal and child epidemiologist at the Division of Public Health Services, said. She told lawmakers three of the 2023 deaths were from substance-use overdose, two from cardiovascular causes, and one was a homicide; the MMRC aggregates multi-year data to assess trends.
The MMRC said substance use disorders and mental-health conditions were leading contributors in pregnancy-related deaths. In five-year aggregate data (2019–2023), the committee found that 50% of pregnancy-related deaths were due to drug overdose and that 79% of those aggregated pregnancy-related deaths were determined to be preventable.
The committee highlighted that a majority of overdose deaths occurred postpartum, between three months and one year after delivery, and that most of those who died of overdose were Medicaid recipients. MMRC members tied financial and transportation barriers to reduced access to care in many of the reviewed cases.
Allison Tower, perinatal nurse consultant for the Maternal and Child Health Section, said the MMRC’s multidisciplinary approach aims to identify clinical and nonclinical interventions. "The function of the Maternal Mortality Review Committee... is to conduct comprehensive multidisciplinary reviews of maternal deaths, to identify factors that contributed to those deaths, and to make actionable recommendations," Tower said.
Presenters credited recently approved postpartum Medicaid expansion — extended coverage through one year postpartum — as an important step that the committee previously recommended and said the policy should increase behavioral-health service utilization for the postpartum period, when many overdose deaths occur.
The MMRC also recommended partnering with the Department of Corrections for clinical education on managing pregnant and postpartum women in correctional settings and continuing regional clinical education efforts through the Northern New England Perinatal Quality Improvement Network based at Dartmouth Health.
Committee members asked whether the recent decline in reported maternal mortality represents a steady trend or year-to-year variation. Yamasege cautioned that low absolute counts can cause large percentage swings and said while data suggest improvement from pandemic-era peaks, year-to-year variation remains.
Ending: Presenters said the finalized, full report will be posted online and will include appendices with pregnancy-associated deaths and detailed recommendations. The committee emphasized mental-health and substance-use services, improved care coordination and clinical education as priorities.
