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Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012

Baeva, Sonia, MA; Saxton, Debra, L., MS; Ruggiero, Karen, PhD; Kormondy, Michelle, L., BS; Hollier, Lisa, M., MD, MPH; Hellerstedt, John, MD; Hall, Manda, MD; Archer, Natalie, P., PhD

doi: 10.1097/AOG.0000000000002565
Contents: Original Research

OBJECTIVE: To more accurately estimate the 2012 maternal mortality ratio for Texas using an enhanced method for identifying maternal deaths.

METHODS: This population-based descriptive study used both data matching and record review to verify pregnancy or delivery within 42 days for 147 deaths with obstetric cause-of-death codes, and used data matching alone to identify additional maternal deaths within the same timeframe. Crude maternal mortality ratios were calculated for confirmed maternal deaths overall, by race and ethnicity, and by age. These maternal mortality ratios were compared with maternal mortality ratios computed using obstetric cause-of-death codes alone (standard method).

RESULTS: Fifty-six maternal deaths were confirmed to have occurred during pregnancy or within 42 days postpartum. Using our enhanced method, the 2012 maternal mortality ratio for Texas was 14.6 maternal deaths per 100,000 live births, less than half that obtained using the standard method (n=147). Approximately half (50.3%) of obstetric-coded deaths showed no evidence of pregnancy within 42 days, and a large majority of these incorrectly indicated pregnancy at the time of death. Insufficient information was available to determine pregnancy for 15 obstetric-coded deaths, which were excluded from the 2012 maternal mortality ratio estimate; however, had these deaths been included, the resulting maternal mortality ratio would still be significantly lower than that reported using the standard method.

CONCLUSION: Relying solely on obstetric codes for identifying maternal deaths appears to be insufficient and can lead to inaccurate maternal mortality ratios. A method enhanced with data matching and record review yields more accurate ratios. Results likely have national implications, because miscoding of obstetric deaths with the standard method may affect the accuracy of other states' maternal mortality ratios.

An enhanced method to identify maternal deaths resulted in a significantly lower 2012 maternal mortality ratio for Texas than those obtained using obstetric cause-of-death codes.

Division for Community Health Improvement, Texas Department of State Health Services, Austin, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, and the Texas Department of State Health Services, Austin, Texas.

Corresponding author: Natalie P. Archer, PhD, Maternal & Child Health Epidemiology, Division for Community Health Improvement, Texas Department of State Health Services, 1100 W 49th Street, MC 1642, PO Box 149347, Austin, TX 78714; email: natalie.archer@dshs.texas.gov.

Supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under Grant Number B04MC2937, Texas Title V Maternal and Child Health Services ($33,899,658, 100%).

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Ashley Hill for her help with this investigation. They also thank members of the Texas Department of State Health Services Center for Health Statistics for their help preparing needed data files and Victor Farinelli for his data support.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.