Health and Social Disparities Among Pregnancy-Related Deaths in California

California's maternal mortality rate in 2006 was 16.9 per 100,000 live births and rates for African-Americans were four times greater than Whites. The California Pregnancy-Associated Mortality Review (CA-PAMR) is a systematic review of pregnancy-related deaths (deaths within one year postpartum) that identifies causes of death, contributing factors, and opportunities for improvement. Data from medical and coroner records were abstracted for 146 deaths likely to be pregnancy-related in the years 2002-2003; 98 were determined to be pregnancy-related. These women differed significantly (p<0.05) from all California births by race and payer source. African-American women accounted for as much as 22% of the pregnancy-related deaths but only 6% of California births. A larger proportion of the pregnancy-related deaths were among women who were covered by MediCal (57%) compared with 44% of all California births. MediCal coverage did not differ significantly among racial/ethnic groups.

Among the 98 deaths, African-American women had a higher chance of dying of cardiomyopathy than other racial/ethnic groups (36.4% vs. 6.6% respectively), had higher average body mass index (BMI) (32.5% vs. 26.5%), were categorized as higher risk upon entry to prenatal care and went to the emergency room more often than women of other groups. Medical records indicate that MediCal-funded women were more likely than those with HMO/private coverage to be smokers (22.2% vs. 5.7%) use other drugs (excluding alcohol) (19.6% vs. 2.8%), be unmarried (60.4% vs. 22.0%), and die greater than 42 days postpartum (10.7% vs. 0.0%).