Health Indicator Report of Maternal Mortality
Approximately 700 women die each year in the United States as a result of pregnancy or delivery complications (CDC). The death of a woman during pregnancy, delivery, or after delivery is a tragedy for her family and for society as a whole. Surveillance of maternal mortality identifies ways to improve the health, health behaviors, and health care of women before, during, and after pregnancy. Surveillance also identifies gaps in the health care system, social services, health care access, and the quality of prenatal and postnatal care.
The final determination about whether a death is categorized as pregnancy-related is made by the Utah Perinatal Mortality Review committee. Over time the composition of the committee and the information available has changed, affecting how deaths are categorized. In 2015, the committee began using standardized criteria to determine when an overdose or suicide death was pregnancy-related. These criteria were published in 2020 (Standardized Criteria for Review of Perinatal Suicides and Accidental Drug-Related Deaths, Smid, et al, [http://pubmed.ncbi.nlm.nih.gov/32925616/]). Because the total number of maternal deaths is low, the change in categorization for even one death affects the mortality rate significantly.
Pregnancy-related Mortality Ratio, Utah and U.S., 2005-2019
NotesMaternal deaths are identified through the pregnancy checkbox or cause of death codes on death certificates, or by matching birth and death certificates. The Utah Perinatal Mortality Review Committee then determines whether each of those deaths was related to the pregnancy or not. Deaths determined to be pregnancy-related are included in the ratio. The U.S. data shown are from the CDC Pregnancy Mortality Surveillance System (PMSS), which summarizes and analyzes maternal death certificates and matching fetal death/birth certificates from 52 reporting areas. Maternal mortality data reported by PMSS is not yet available for years after 2017. [https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm] The U.S. data presented here are most comparable to the Utah data, however, the case identification and classification methodologies differ slightly.
- Office of Vital Records and Statistics, Utah Department of Health
- National Vital Statistics System, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention
Data Interpretation IssuesThe CDC Perinatal Mortality Surveillance System and the data presented here include pregnancy-related deaths during pregnancy and up to 365 days after the end of a pregnancy. The World Health Organization and Healthy People 2030 define maternal death as the death of a woman while pregnant or within 42 days of the end of a pregnancy, from a pregnancy-related cause. Care should be taken to clarify whether data are based on a 42 day or 365 day time period and whether data refer to pregnancy-related deaths or pregnancy-associated deaths.
Definition'''Maternal mortality''' is a general term referring to the death of a woman during pregnancy or within a year of the end of pregnancy. A '''pregnancy-related death''' is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. A '''pregnancy-associated, but not related death''' is the death of a woman during pregnancy or within one year of the end of pregnancy from a cause that is not related to pregnancy. The '''pregnancy-related mortality ratio''' is the number of pregnancy-related deaths per 100,000 live births.
NumeratorNumber of pregnancy-related deaths per year
DenominatorTotal number of live births per year
Healthy People Objective MICH-5:Reduce the rate of maternal mortality
U.S. Target: 11.4 maternal deaths per 100,000 live births
State Target: 11.4 maternal deaths per 100,000 live births
Other ObjectivesHealthy People 2030 Objective MICH-04 aims to reduce the maternal mortality rate to 15.7 maternal deaths per 100,000 live births. This measure uses the definition of death while pregnant or within 42 days of being pregnant related to obstetric causes.
How Are We Doing?The Utah pregnancy-related mortality ratio in 2019 was 25.6 (per 100,000 live births).
How Do We Compare With the U.S.?Comparison between Utah and U.S. rates is complicated by differences in methodology when defining pregnancy-relatedness. As can be seen in the graph, the U.S. maternal mortality ratio has slowly increased over the last several decades. Some of the increase is undoubtedly due to improved data collection. Other possible causes may be increased Cesarean section rates over time, which increases risks to maternal health. The general health of the childbearing population may influence the rate as well, with increases in heart disease, hypertension, diabetes, other chronic conditions, and mental health disorders complicating pregnancy more frequently than they did in the past. Women may also experience more barriers to accessing affordable health care, which may increase health risks during and after pregnancy. More detailed information can be found here [https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm].
What Is Being Done?The Utah Department of Health conducts ongoing maternal and infant mortality surveillance through the Perinatal Mortality Review program. Public education is provided on the importance of planning for pregnancy, preconception and interconception health, and recognition and treatment of maternal anxiety and depression. The Utah Women and Newborns Quality Collaborative (UWNQC) addresses issues of quality improvement in maternal and infant health care.
Evidence-based PracticesUtah collaborates with The Alliance for Innovation on Maternal Health (AIM) to promote consistent and safe maternity care. The AIM has developed patient safety bundles, a package of evidence-based best practices for implementation in clinical settings. Safety bundles address the leading causes of maternal mortality and are designed to reduce maternal deaths related to obstetrical complications. In 2020 and 2021, Utah worked on the implementation of the Obstetric Care for Women with Opioid Use Disorder bundle. In 2020, a new website was launched to make it easier to find a mental health care provider with expertise in perinatal mental health. This resource can be found at [http://maternalmentalhealth.utah.gov/].
Available ServicesFind providers trained in perinatal mental health based on provider type, location or insurance accepted at [https://maternalmentalhealth.utah.gov/]. Postpartum Support International-Utah provides extensive resources for maternal mental health. Visit their website at [https://www.psiutah.org/]. St. Mark's Hospital offers an intensive outpatient program for the treatment of perinatal mood disorders. More information is available at [https://stmarkshospital.com/service/perinatal-outpatient-program]. The University of Utah SUPeRAD clinic specializes in care for pregnant women with substance addictions. Call 801-581-8425 for more information. To find local substance use disorder and mental health treatment options, visit [https://dsamh.utah.gov].
Page Content Updated On 03/30/2022, Published on 04/15/2022