Report: Most pregnancy-related deaths in Missouri are avoidable

Four of every five pregnancy-related deaths in Missouri are preventable.

That’s one of several key findings of a new report issued Wednesday by the Missouri Department of Health and Senior Services (DHSS) examining maternal mortality in the state.

The first-of-its-kind report was published by the state’s Pregnancy-Associated Mortality Review (PAMR) board and was based on the deaths of the 60 Missouri women who died while pregnant or within a year of pregnancy in 2017, the most recent year for which data was available.

The PAMR board is a multidisciplinary panel of medical experts from across the state and was tasked with studying the causes and contributing factors associated with maternal mortality and also looked at potential steps that can be taken to prevent similar deaths from occurring in the future.

For the purposes of the report, a “pregnancy-associated” death was defined as the death of a woman within a year of her pregnancy that was not a direct result of the pregnancy, while a “pregnancy-related” death was directly attributable to a woman’s pregnancy.

In addition to determining 80% of Missouri’s 2017’s pregnancy-related deaths could have been avoided, the report, titled “Missouri Pregnancy-Associated Mortality Review: 2017 Annual Report,” contains several other key findings, including:

• The pregnancy-related mortality ratio in Missouri in 2017 was 26 deaths per 100,000 live births.
• The rate of pregnancy-related deaths was more than four times higher for women who were more than 40 years old compared to those in the 20 to 29 age range.
• The rate of pregnancy-related deaths among women who were obese was more than 2.5 times greater than the rate among women who were not obese.
• Unmarried women had a pregnancy-associated and pregnancy-related death rate that was roughly five times greater than the rate for married women.
• The rate of pregnancy-associated deaths among Black women was more than four times greater than the rate of deaths among white women.
• A majority (57%) of verified deaths occurred between 43 days and one year after pregnancy.
• The leading cause of injury-related, verified deaths were motor vehicle crashes (41%), followed by overdoses/poisonings (33%).
• Substance-use disorder contributed to 44% of pregnancy-associated and 16% of pregnancy-related deaths.
• Cardiomyopathy, diseases that affect the heart muscle, was the leading underlying cause of pregnancy-related deaths (26%).
• Mental health conditions contributed to 27% of pregnancy-associated and 16% of pregnancy-related deaths.
• The rate of pregnancy-associated deaths for women in Missouri on Medicaid was more than five times greater than the rate for those with private insurance.

According to DHSS, the PAMR board has almost completed its review of 2018 maternal morbidity statistics and will soon begin reviewing 2019 death data. These reports, the agency said, will be available once all cases have been reviewed.

The 2017 report, including the PAMR board’s recommendations, is available online at www.health.mo.gov/data/pamr.