Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016 : Obstetrics & Gynecology

Secondary Logo

Journal Logo

Advanced Search
Contents: Original Research

Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016

Mehta, Pooja K. MD, MSHP; Kieltyka, Lyn PhD, MPH; Bachhuber, Marcus A. MD, MSHP; Smiles, Dana MPH, MA; Wallace, Maeve PhD, MPH; Zapata, Amy MPH; Gee, Rebekah E. MD, MPH

Author Information

Center for Healthcare Value and Equity, Section of Community and Population Medicine, Department of Medicine, the Department of Obstetrics & Gynecology, and the Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, the Bureau of Family Health, Office of Public Health, Louisiana Department of Health, the Mary Amelia Community Women's Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, and the Louisiana Department of Health, Baton Rouge, Louisiana.

Corresponding author: Pooja K. Mehta, MD, MSHP, Center for Healthcare Value and Equity, Section of Community and Population Medicine, Department of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA; email: [email protected].

Dr. Wallace's role in this research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health under award numbers R01HD092653 and R01HD096070.

Financial Disclosure Pooja Mehta disclosed receiving from the American College of Osteopathic Obstetricians & Gynecologists, and they received reimbursement for travel by the Physicians for Reproductive Health. Dana Smiles disclosed that she was employed by Louisiana State University Health Sciences Center as a Program Manager/Advisor. Amy Zapata is an employee of the State of Louisiana - Office of Public Health and oversees the state's Title V Maternal and Child Health Block Grant. As described in the article, the mortality review is a Title V–supported activity. No additional compensation was provided to her for any work related to the review or article. The other authors did not report any potential conflicts of interest.

The authors thank the Louisiana Maternal Mortality Review team, whose review of maternal death cases made this analysis possible: Dr. Alfred Robichaux, Ms. Cheri Johnson, Dr. Dori Binder, Dr. Erin O'Sullivan, Dr. Joseph Biggio, Dr. Marshall Amant, and Dr. Scott Barrilleaux. The authors also thank the Louisiana Vital Records Office for providing the data used to identify maternal death cases and the Bureau of Family Health Regional and Maternal and Child Health Coordinators who abstracted records, facilitating review. Finally, the authors wish to acknowledge and honor those who experienced a pregnancy-related death in Louisiana between 2011 and 2016, their families, and their communities.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at https://links.lww.com/AOG/B672.

Obstetrics & Gynecology 135(2):p 276-283, February 2020. | DOI: 10.1097/AOG.0000000000003591

OBJECTIVE: 

To examine preventable pregnancy-related deaths in Louisiana by race and ethnicity and maternal level of care to inform quality improvement efforts.

METHODS: 

We conducted a retrospective observational descriptive analysis of Louisiana Pregnancy-Associated Mortality Review data of 47 confirmed pregnancy-related deaths occurring from 2011 to 2016. The review team determined cause of death, preventability, and contributing factors. We compared preventability by race–ethnicity and maternal level of care of the facility where death occurred (from level I: basic care to level IV: regional perinatal health center) using odds ratios (ORs) and 95% CIs.

RESULTS: 

The rate of pregnancy-related death among non-Hispanic black women (22.7/100,000 births, 95% CI 15.5–32.1, n=32/140,785) was 4.1 times the rate among non-Hispanic white women (5.6/100,000, 95% CI 2.8–10.0, n=11/197,630). Hemorrhage (n=8/47, 17%) and cardiomyopathy (n=8/47, 17%) were the most common causes of pregnancy-related death. Among non-Hispanic black women who experienced pregnancy-related death, 59% [n=19] of deaths were deemed potentially preventable, compared with 9% (n=1) among non-Hispanic white women (OR 14.6, 95% CI 1.7–128.4). Of 47 confirmed pregnancy-related deaths, 58% (n=27) occurred at level III or IV birth facilities. Compared with those at level I or II birth facilities (n=2/4, 50%), pregnancy-related deaths occurring at level III or IV birth facilities (n=14/27, 52%) were not less likely to be categorized as preventable (OR 2.0, 95% CI 0.5–8.0).

CONCLUSION: 

Compared with non-Hispanic white women, pregnancy-related deaths that occurred among non-Hispanic black women in Louisiana from 2011 to 2016 were more likely to be preventable. The proportion of deaths that were preventable was similar between lower and higher level birth facilities. Hospital-based quality improvement efforts focused on addressing hemorrhage, hypertension, and associated racial inequities may prevent pregnancy-related deaths in Louisiana.

© 2020 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Full Text Access for Subscribers:

Log in here >
ACOG Members, please click “Log in here” to access content
Log in here >

Not a Subscriber?

Buy
Request Permissions
Become a Society Member

You can read the full text of this article if you:

Access through Ovid