Understanding Pregnancy-Related Deaths in Ohio in 2021

By Sydney Tavens, PAMR Data Analyst, The Ohio Department of Children and Youth

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The death of a woman during pregnancy or within one year after the end of pregnancy represents a profound loss with lasting impacts. Ohio’s Pregnancy-Associated Mortality Review (PAMR) plays a critical role in the state’s public health strategy around preventing these deaths. The PAMR committee reviews every death occurring during pregnancy or within the first year postpartum to determine whether it was pregnancy-related, identify‑ contributing medical and social factors, and assess preventability. Based on these findings, the committee issues actionable recommendations aimed at strengthening systems of care and reducing future pregnancy‑related deaths.

Key Definitions: Understanding the definitions of terms used to describe deaths that occur during and within one year of the end of pregnancy is crucial as similar-sounding terms measure different outcomes. Below are the definitions of terms that align with Ohio PAMR data:

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

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

• Pregnancy-related death: The death of a woman while pregnant or within one year of the end of pregnancy, regardless of duration and site of pregnancy, from any cause related to or aggravated by her pregnancy or its management (e.g., from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy).

  
  

The committee determines this by asking, “Would this person have died if they had not been pregnant?”

• Unable to determine: The death of a woman while pregnant or within one year of the end of pregnancy, due to a cause that could not be determined to be pregnancy-related or not pregnancy-related.

The review of pregnancy-associated deaths is a complex, sensitive, and detail-driven process that relies on sustained investment in the expertise of state staff and a multidisciplinary committee. Completing a full review cycle for a single year of cases typically requires 18 to 24 months, reflecting the level of rigor needed to produce meaningful findings. While the PAMR process generates the most reliable maternal death data for Ohio, the depth and accuracy of the review play a role in the delay between when deaths occur and when finalized data becomes available.

2021 Report Highlights: The Ohio Department of Children and Youth recently released its report reflecting the pregnancy-related deaths that occurred during the 2021 calendar year. This report reflects years of work by the PAMR staff and committee and is dedicated to the memory of the 140 women who died from pregnancy-associated causes in 2021.

• Among the 135 deaths that the committee reviewed (5 were unable to be reviewed due to open investigation), more than one-third (36%) of the pregnancy-associated deaths were found to be directly related to or aggravated by pregnancy.

• In 2021, Ohio’s Pregnancy-Related Mortality Ratio (PRMR) was 36.9 deaths per 100,000 live births. Using the PRMR gives Ohio a consistent, comparable measure that allows Ohio to track pregnancy-related deaths over time, across regions, and among demographic groups. Reporting the number of pregnancy-related deaths alone cannot support these comparisons because it does not reflect differences in population size.

  
  

  

• 88% of pregnancy-related deaths were preventable.

• Non-Hispanic Black (NHB) women were disproportionally affected by pregnancy-related deaths in 2021.

• Infection, including COVID-19 and sepsis, accounted for 35% of all pregnancy-related deaths, followed by mental health conditions, thrombotic embolism, and cardiovascular conditions.

• The PAMR committee examines the factors that contributed to each death and organizes them into categories developed by the Centers for Disease Control and Prevention (CDC). In 2021, the most common contributing factor to pregnancy-related deaths was non-adherence to medical recommendations.

The recommendations written by the PAMR committee affirm that preventing pregnancy-related deaths requires collaboration across providers, healthcare systems, public health organizations, and communities. Our collective work builds on these insights to strengthen the systems and services that promote safe, healthy pregnancies for all Ohioans.

In remembering the 140 lives lost in 2021, we reaffirm our commitment to improving the care and conditions that allow individuals and families to thrive during pregnancy and beyond.

To learn more about Ohio PAMR, please visit our website, and click here to read the full 2021 report. For questions, please reach out to PAMR@childrenandyouth.ohio.gov

Sydney Tavens serves as the data analyst 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 of Public Health with a specialization in epidemiology from The Ohio State University. Previously, she has worked in harm reduction where she distributed harm reduction resources across Ohio and analyzed state overdose data. She is passionate about advancing maternal health and using data to shape policies and initiatives that prioritize disproportionately impacted populations.