Connecticut Takes Small Step Toward Supporting Maternal Mortality Review
HARTFORD, CT — The Centers for Disease Control and Prevention found that 700 women in the United States die each year as a result of pregnancy or pregnancy-related complications, and the rate has more than doubled since 1987. Pregnancy-related deaths per 100,000 live births rose from 7.2 nationally in 1987 to 17.3 in 2013, peaking at 17.8 in 2009 and 2011.
In Connecticut, there were eight pregnancy-related deaths from 2011 to 2014. But there’s no data available yet for the years since 2014 and at the moment there are precious few dollars devoted to accessing it.
On Tuesday, Gov. Dannel P. Malloy signed a bill into law that would establish a Maternal Mortality Review Program within the state Department of Public Health to conduct a comprehensive, multidisciplinary review of maternal deaths.
But part of getting at the problem of maternal death and making recommendations about how to prevent it involves data collection and analysis. Over the past few years the state has eliminated the funding for its previous effort — the Maternal Mortality Review Committee — which had been housed at the Connecticut State Medical Society. Previously, the state had provided funding to the committee to support the process of reviewing the medical charts of mothers who died in childbirth. However, those funds went from $104,000 in 2015 to zero in this year’s budget.
The one physician who is charged with reviewing the cases — Dr. Andrea Desai — only recently received mortality data from the Department of Public Health for 2015 and 2016.
Dr. Desai is a clinical instructor and maternal fetal medicine fellow at the Yale School of Medicine & Yale-New Haven Hospital. She said the data the committee analyzes helps to determine why women are dying during and after pregnancy.
“If we don’t understand the contributing factors and potential causes, there is no way to figure out and establish prevention strategies, which is the ultimate goal,” Desai said. “Maternal mortality has been highlighted on a national scale during the past year and is clearly a nationwide problem, but that does not necessarily mean that the reasons why women are dying are the same across the U.S. Having access to this data and being able to review these cases is critical. And it is how we will be able to start on a path to highlighting and targeting specific areas where we can make an impact locally.”
The eight pregnancy-related deaths between 2011 and 2014 were caused by a variety of conditions including suspected diabetes inspidus, postpartum cardiomyopathy, HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelets) syndrome leading to multiple organ failure, intraventricular hemorrhage, cardiogenic shock, ruptured ectopic pregnancy, and thrombo-embolic disease.
The legislation Malloy signed Tuesday — SB 304: An Act Establishing A Maternal Mortality Review Program And Committee Within The Department Of Public Health — doesn’t include a boost in funding for the work of Dr. Desai and her colleagues at the Department of Public Health. It simply modifies provisions regarding membership and duties of the Maternal Mortality Review Committee. It also added a provision establishing a Maternal Mortality Review Program within the Department of Public Health.
The increase in the diversity of medical professionals on the committee will help improve recommendations, according to state officials, even if it doesn’t come with any funding.
Two federal bills introduced last year would create a grant program to help states introduce or improve review committees, but the bills seem to have stalled.
Funding for these types of review committees varies by state. Some are volunteer efforts like Connecticut’s while others like the one recently passed in Oregon received $450,000 over five years for its program.
Desai said she travels the state reviewing the medical charts of women who may have died from pregnancy-related causes. She has permission from the Department of Public Health to review those charts at the hospital where the death occurred, and brings the information back to the committee.
The legislation expanding the number of committee members goes into effect on Oct. 1, but it doesn’t help resolve the lack of access to timely data for the committee’s review.
In Connecticut, there’s currently a two or three year delay in the committee’s ability to link of the maternal death certificate with the birth certificate. Desai said one way to improve access to the mortality data would be to formalize an agreement between the hospitals and the committee that would allow the hospital to submit in-hospital deaths that may be pregnancy related to the committee for review “without fear of punishment, investigation or litigation.”
Those who opposed the bill originally, like the Connecticut Hospital Association, were concerned about the privacy of the data. However, those concerns were eliminated when the Senate amended the final version of the bill that Malloy just signed.