In September, the Wolf Administration received a $2.25 million grant from the Centers for Disease Control and Prevention to support the Pennsylvania Maternal Mortality Review Committee’s efforts. The department will receive this grant over five years.
Aasta Mehta MD, MPP, FACOG, Women’s Health Policy Advisor with Philadelphia Department of Public Health, explained what this grant means for Philadelphia mothers specifically. “The CDC grant provides funding to strengthen the surveillance process for maternal mortality in Pennsylvania. Philadelphia accounts for approximately 20 to 25 percent of maternal deaths in Pennsylvania,” said Dr. Mehta. “Therefore, a portion of the funding will go directly to Philadelphia to strengthen our surveillance process.”
The Pennsylvania Maternal Mortality Review Committee (PA MMRC) reviews all pregnancy-related deaths in the state, regardless of cause of death. Pregnancy-associated deaths are defined as the death of a woman during pregnancy, or up to one year following the end of the pregnancy, regardless of the pregnancy outcome. This includes drug-related deaths, homicides and suicides. The state determines if the death was related to the pregnancy, identifies contributing factors, then determines if the death was preventable and offers recommendations to prevent future deaths.
As a member of the mortality review team, Dr. Mehta found the most common causes of pregnancy-related mortality in Philadelphia are cardiovascular-related conditions and embolism. The most common cause of overall mortality is drug overdoses. “Racial disparities are also present, specifically in pregnancy-related mortality. Our preliminary data shows that Black, non-Hispanic women are four times more likely to die of pregnancy-related deaths than white, non-Hispanic women,” she said. “In order to meaningfully move the needle on maternal mortality in Philadelphia, focus needs to be placed on three priority populations: women with high blood pressure or preeclampsia, women with substance use disorder, and African American women.”
Maternal mortality data surveillance has recently become standardized with recommendations by the CDC. Dr. Mehta explained that, “The CDC funding will support the current Nurse Abstractor to align the Philadelphia process with these recommendations, using the MMRIA data collection tool toward developing a fuller case review.” She added, “Improving the maternal mortality surveillance will ensure that recommendations put forth by the Philadelphia team will address the root cause of mortality and accurately inform interventions. Aligning the Philadelphia review process with national standards enables data to be generalizable with maternal mortality review committees from other areas.”
The total number of maternal deaths in the United States is not high when compared with deaths due to heart disease and cancer. However, Dr. Mehta said it is a really important number because a maternal death is a measure of the overall strength and effectiveness of our health care system. A maternal death showcases the gaps in our service delivery system which is why it is a reportable sentinel event. In addition, a death of a mother affects not only her immediate family but all of the people around her (parents, siblings, friends) and that effect lasts for generations.
The data in Philadelphia is in accordance with trends seen in other states and on the national level. “What is unique about the maternal mortality in Philadelphia is our large number of drug-related deaths and the very small number of deaths due to hemorrhage,” Dr. Mehta concluded. “We attribute the small number of deaths due to hemorrhage to the fact that all of our delivery hospitals have worked hard to employ evidence-based safety measures in place to respond quickly to maternal hemorrhage.”
The CDC reports most pregnancy-related deaths occur after pregnancy. Among these deaths nationally, 31 percent occur while pregnant, 36 percent occur at delivery or in the following week, and 33 percent occur one week to one year after pregnancy.