Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012

Abstract

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.

Maternal risk factor index and cesarean delivery among women with nulliparous, term, singleton, vertex deliveries, Texas, 2015

“…17 Weight status, classified as normal/underweight and overweight/obese, was created based on age-specific BMI percentile thresholds and BMI thresholds per CDC cut points for those 15-19 years of age and ≥20 years of age, respectively. 16 The covariates selected in the analyses included two domains: (a) sociodemographic factors (maternal age [15-19 years, 20-34 [1][2][3][4][5][6][7][8][9][10][11]) and (b) prenatal factors (gestational weight gain and prenatal care use). Gestational weight gain was calculated from mother's prepregnancy weight and her weight at delivery in pounds and operationalized as those who gained weight above Institute of Medicine (IOM) recommendations versus those whose weight gain was adequate or below IOM recommendations.…”

“…1 Recent reports of the high maternal mortality rate 8 have drawn attention to the need to understand contributing factors to maternal deaths in Texas. 9 The increase in maternal mortality has been attributed to many factors, including more women having cesarean delivery that may lead to complications. 10 Cesarean delivery accounts for over one-third of all births occurring annually in Texas (~400 000), with 20% of all deliveries being first-time cesarean deliveries.…”

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

“…Most importantly, maternal health and safety in Texas has been the subject of substantial discussion and legislative attention since a 2016 study found that Texas's maternal mortality rate had nearly doubled from 2010 to 2012, resulting in an overall increase that was substantially higher than the national average . Subsequent analysis discovered that many deaths that had been identified on death certificates as maternal deaths were in fact miscoded, inflating the numbers . Both the controversy and the correction, however, brought attention to several important aspects of maternal health and safety in Texas .…”

“…18,19 Subsequent analysis discovered that many deaths that had been identified on death certificates as maternal deaths were in fact miscoded, inflating the numbers. 20 Both the controversy and the correction, however, brought attention to several important aspects of maternal health and safety in Texas. 5,21 The high rates of maternal mortality and morbidity in Texas along with its substantial racial/ethnic disparities, and geographic and population diversity, warrant (a) a closer examination of how medical (chronic and behavioral) and obstetric (pregnancyinduced) conditions are associated with SMM in Texas and (b) a need for collective actions by policymakers and clinicians to improve maternal outcomes.…”

Checking the pregnancy checkbox: Evaluation of a four‐state quality assurance pilot

“…A Texas study found an 87% increase in maternal deaths comparing 2006‐2010 to 2011‐2015 data . A subsequent Texas study found that 50% of obstetric‐coded deaths in 2012 showed no evidence of pregnancy within 42 days of death after data‐matching—suggesting that the reported increase in maternal deaths was inflated by pregnancy checkbox errors . These studies question the accuracy of United States maternal death data, highlighting the necessity of data quality improvement measures …”