Understanding Pregnancy-Related Deaths in Ohio

By Hallie Kerr, MPH, LMT

PAMR Coordinator, Ohio Department of Children and Youth

Follow Hallie on LinkedIn or reach her at Hallie.Kerr@childrenandyouth.ohio.gov.

The loss of someone during pregnancy or within a year of giving birth is a tragedy that deeply affects both families and communities. Many of these deaths are preventable, which is why Ohio’s Pregnancy-Associated Mortality Review (PAMR) committee is dedicated to reviewing each death. The committee conducts thorough reviews of all deaths that occur during pregnancy or within a year postpartum to determine if the death was related to pregnancy, what factors contributed to the death, and whether it was preventable. They also provide actionable recommendations to help prevent similar deaths in the future.

This work is complex and demanding, requiring time, resources, and a skilled team of dedicated professionals at the state as well as the multidisciplinary review committee. This work also carries a heavy emotional toll. While the PAMR process provides the most accurate maternal mortality data for the state, it is also a lengthy one. The Ohio Department of Children and Youth recently released its report reflecting pregnancy-related deaths that occurred during calendar year 2020.

Key Definitions: When discussing maternal mortality, it's crucial to understand the definitions, as similar-sounding terms often refer to different measures:

• Pregnancy-associated death: The death of a person during pregnancy or within one year postpartum, regardless of the cause.

  • This is the pool of deaths PAMR starts with and reviews all deaths that meet this definition each year.

• Pregnancy-related death: A death directly caused or influenced by pregnancy. The committee determines this by asking, “Would this person have died if they had not been pregnant?”

• Unable to determine: Cases where insufficient records or information prevent determining if a death was pregnancy related.
  

2020 Report Highlights This report reflects years of work by the PAMR team and committee and honors the memory of the 130 individuals who died from pregnancy-associated causes in 2020. Below are some key findings:

• PAMR reviewed 127 of the 130 cases; 3 were still under investigation.

• Among the reviewed cases, 23% (35 deaths) were identified as pregnancy related.

  • To better understand how often pregnancy-related deaths occur in a population, we use a measure called the Pregnancy-Related Mortality Ratio (PRMR). In 2020, Ohio's PRMR was 27.1 deaths per 100,000 live births. (The graphic below provides an example of how this ratio is calculated.)

• 66% of pregnancy-related deaths were preventable.

• Demographic differences:

  • Non-Hispanic Black women were 1.5 times more likely to die from pregnancy-related causes compared to non-Hispanic white women.

  • PRMR: 38.5 deaths per 100,000 live births for Black women vs. 25.7 deaths for white women.

• Leading cause of death: Infection, including COVID-19 and sepsis, accounted for 31% of deaths. Nearly half (45%) of these deaths were preventable.

• The PAMR committee examines the factors that contributed to each death and categorizes them according to the system developed by the Centers for Disease Control and Prevention (CDC). In 2020, the most common contributing factor to pregnancy-related deaths was inadequate assessment of risk.

Looking Forward, based on the recommendations made by the PAMR committee, preventing pregnancy-related deaths requires collaboration across providers, healthcare systems, public health organizations, and communities. PAMR emphasizes that these efforts must go beyond survival—we aim to create an environment where mothers and pregnant women can thrive.

Through this work, we honor the 130 lives lost in 2020 and are committed to building a safer future for all.

To learn more about PAMR, please visit our website, and click here to read the full report. For questions, please reach out to Hallie.Kerr@childrenandyouth.ohio.gov

Hallie Kerr serves as the Coordinator for Ohio’s Pregnancy Associated Mortality Review Committee at the Ohio Department of Children and Youth. She holds a Bachelor of Science in Public Health and a master’s degree in Population Health Management and Leadership from The Ohio State University. She is also the recipient of the Association of Maternal and Child Health Programs (AMCHP) Emerging Public Health Professional Award for region V. Her previous experience includes maternal wellness project management, early childhood research, and home visiting. She is deeply committed in eliminating health inequities and improving the health, wellness, and birthing experiences for all women and birthing people.