maternal mortality in georgia through the public health lens
DESCRIPTION
Healthy Mothers Healthy Babies 2014 Annual Meeting & Conference October 7th, 2014 Presented by: Maria Fernandez Georgia Department of Public HealthTRANSCRIPT
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Maternal Mortality in Georgia: Through the Public Health Lens
Presenter: Maria Fernandez
Healthy Mothers, Healthy Babies Annual Meeting
Oct 7, 2014
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IN 2013
85 WOMEN DIED
MATERNAL MORTALITY
G E O R G I A RA N K S
# 50
N A T I O N A L LY
AWHONN 2013
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Overview
Inform Protect Prevent
COLLECTIVE IMPACT
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Evolution of Maternal Mortality Definition
1975 1980 1985 1990 1995 2000 2005 2010
2003-present5 supplemental fields added to death certificate to determine death timing in relation to pregnancy.
1992Other states add separate pregnancy question to track time of death.
1900-1979: ICDDeath of a pregnant woman or recently pregnant woman as a result of complications of pregnancy or childbirth.
1979: ICD ExpansionExplicit ICD codes broadened. Parameters added to focus on time of death within 42 days post-partum.
1999-2003ICD-10 change include direct obstetric deaths, indirect obstetric deaths, late maternal death and pregnancy-related death. Results in CDC DRH, NVSS and ICD using different terms for similar concepts.
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INFORM:
Epidemiology of Maternal Mortality
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Worldwide Maternal Mortality: 2013
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Worldwide Maternal Mortality: 1990-2013
North & South America
North & South America
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United States Maternal Mortality: 1987-2010
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Maternal Mortality: United States
50,000suffer severe morbiditiesdue to pregnancy-related complications
For women in the United States, each year:
650die
due to p regnancy-
re la ted compl i ca t ions
This means that for every 1 woman who dies due to a pregnancy-related condition, another 76 women experience a severe co-morbidity. 70%
in20
years
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Georgia Maternal Mortality Rate 2002-2012
Source: Georgia Vital Statistics
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
10
20
30
40
50
60
70
Rati
o (
Per
1,0
00
) live b
irth
s
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Georgia Maternal Mortality Initiatives
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Georgia Maternal Mortality Initiatives
Partnership with Emory University
Medicaid Policy Changes
Maternal Mortality Review Committee
1
2
3
Working with Emory to expand midwifery training programs
• P4HB to increase family planning• Payment for LARCs at delivery
Partnership with the Georgia OB/Gyn Society to lead the MMRC
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Georgia Maternal Mortality Review Committee
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MMRC Members
Chair- Dr. Michael Lindsay
Clinicians
Public Health
Practitioners
Mental Health
Providers
Coordinator: Debbie
Sibley
Chart Abstractors
Sub Committee
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Purpose of the MMRC
• Identify all maternal deaths in Georgia• Review maternal deaths that are/may be
pregnancy-related• Determine modifiable factors related to
the death• Develop non-punitive actionable
recommendations• Reduce maternal death
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Case review criteria
Maternal Death• Death must have occurred to a woman
who was either pregnant at time of death or within one year
Pregnancy-Related Maternal Death• Suicides and drug overdoses within six
months • Motor vehicle accidents within six months• Intentional and unintentional injuries not
routinely reviewed
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Maternal Death
Pregnancy Associated Mortality
Pregnancy Related
Mortality
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Maternal death identification process
Deaths Identified
Check Mark Death Certificate
Mandatory Reporting
Vital Records Linkage
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DeathSelect cases for
abstractionCommittee recommend-
ations
MMRC Process
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Limitations on identification process
Identification of maternal deaths are complicated
• What happens if a mom was a resident of a different state at delivery?
• Do you capture deaths related to induced terminations?
Death certificates are not always complete and/or accurate
Fetal death certificates are not routinely completed
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Findings from MMRC
Georgia 2012 Maternal Mortality
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Maternal Mortality, Georgia 2012
Pregnancy-Associated Pregnancy-Related
N = 61
N = 24
85total
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Maternal mortality by timing of death Georgia, 2012
Whi
le P
regn
ant
1-42
day
s po
st-p
artu
m
43-3
65 d
ays
post
-par
tum
0
10
20
30
40
50
60
17 16
52
8 5
48
9 114 Total
Pregnancy-AssociatedPregnancy-RelatedF
req
uen
cy
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Maternal mortality by race Georgia, 2012
Fre
qu
en
cy
White Black Hispanic Other0
5
10
15
20
25
30
35
40
45
Pregnancy Associated
Pregnancy Related
Total
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Maternal mortality by age Georgia, 2012
Fre
qu
en
cy
Less than 20 yrs old
20-24 yrs old
25-29 yrs old
30-34 yrs old
35+ yrs old0
5
10
15
20
25
30
TotalPregnancy Asso-ciatedPregnancy Related
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Maternal mortality by education Georgia, 2012
Less
than
12
year
sHS
Som
e Co
llege
Colle
ge
Colle
ge+
0
5
10
15
20
25
30
Pregnancy Associated
Pregnancy Related
Total
Fre
qu
en
cy
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Maternal mortality by marital status Georgia and payor, 2012
Married Single 0
10
20
30
40
50
60
22
37
10
14
Pregnancy-AssociatedPregnancy-RelatedSeries3
Medicaid Private Self pay Other0
5
10
15
20
25
30
35
40
45
50
31
51
13
13
2
0
0
Pregnancy-AssociatedPregnancy-RelatedSeries3
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Maternal mortality by occupation: Georgia, 2012
35
2
10
17
35
15
26
20
0
5
9
4 1
0
1
1
1
Chart Title
Pregnancy-Associated
Pregnancy-Related
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Maternal mortality by mode of delivery: Georgia, 2012
N=68
Vaginal Cesarean0
5
10
15
20
25
30
35
40
27
37
22
26
5
11
TotalPregnancy AssociatedPregnancy Related
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Leading Causes of Maternal Mortality
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Maternal mortality by cause of death:
Worldwide
Hemorrhage Infection Eclampsia Obstructed Labor
Unsafe Abortion
0
5
10
15
20
25
30
25%
15%
13%
7%
13%
Perc
enta
ge o
f all p
regnancy
-rela
ted
death
s
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Maternal mortality by cause of death:
United States
Cardi
ovas
cula
r di
seas
e
Infe
ctio
n
Non-c
ardi
ovas
cula
r di
seas
e
Cardi
omyo
path
y
Hemor
rhag
e
Thro
mbo
tic p
ulm
onar
y em
bolis
m
Hyper
tens
ive
diso
rder
of p
regn
ancy
cere
brov
ascu
lar ac
cide
nt
amni
otic fl
uid
embo
lism
anes
tesia
com
plicat
ions
0
2
4
6
8
10
12
14
1615%
14%13%
12% 12%
10% 9%
6%5%
1%
Perc
ent
of
all p
regnancy-r
ela
ted d
eath
s
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Maternal mortality by cause of death: Georgia
Cardiac Embolism Seizure disorder Hemorrhage Hypertension Drug overdose0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
21%
17%
13%
8% 8% 8%
Perc
ent
of
all p
regnancy r
ela
ted d
eath
s
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An In-Depth Review of Initially Identified Cases
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Chronic Diseases Apparent During the Prenatal Period, Georgia 2012
N = 34
Depression Diabetes Epilepsy Hypertension Sickle Cell Other0
2
4
6
8
10
12
5
4
6
10
2
11
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Maternal Mortality by pre-pregnancy weight: Georgia 2012
(N=17)
Normal Overweight Obese Morbidly Obese0
1
2
3
4
5
6
7
TotalPregnancy AssociatedPregnancy Related
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Georgia Maternal Mortality Health Promotion Initiatives
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Chronic Disease & Pregnancy Awareness
http://youtu.be/K02elLJotaU
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Cardiac Brochure
Chronic Disease Poster
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SCD Brochure
Diabetes Brochure
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Georgia Maternal Mortality Gap
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October: Domestic Violence Month
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Prevent
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Prevention Strategies
• Expansion of midwives• Increase family planning• Risk screening through prenatal care
• Early detection of problems can lead to better preparation at birth
• If no risks are found could provide a false sense of security
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MMRC current action item
AMCHP Grant• Every Mother’s Initiative grant ($30,000: 1
year)
Focused on risk factors• Chronic diseases
Two arms• Provider education• Patient education
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Protect
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Maternal Mortality Law
SB 273 – Senator Burke• Requires public health to establish a
maternal mortality review committee• Provide legislative findings • Provide data• Provide confidentiality and limited
liability of reviews
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Collective Impact
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Collective Impact
• The risk factors associated with whether a woman lives or dies as a result of pregnancy are the same risk factors that are associated with if a baby lives or dies.
• Understand and address the role of social determinants on maternal death• Housing?• Education?• Finances?
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How you can help?
Providers:• Report maternal deaths• Join our perinatal quality collaborative• Every woman, every time
Public:• Encourage healthy behaviors and lifestyles• Encourage early and regular prenatal care• End domestic violence• Address mental health concerns• Advocate for paid maternity leave
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Food for thought
• What role does the father play in preventing maternal death?
• Social support decreases infant death, what about maternal death?
• What about the mom after the baby is born? – Program support is usually focused on baby– Family support is usually focused on baby
• How can we better focus on women who were recently pregnant, and not just mothers?
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Pregnancy is SPECIAL, Let’s make it SAFE
~Safe Motherhood