Online Program

Pregnancy-associated mortality review in Massachusetts: Using the health impact pyramid to address social and health care disparities

Tuesday, November 5, 2013

Angela Nannini, PhD, FNP-C, FAANP, Department of Nursing, University of Massachusetts Lowell, Lowell, MA
Hafsatou Diop, MD, MPH, Bureau of Family Health and Nutrition- Pregnancy Risk Assessment Monitoring System (PRAMS), Massachusetts Department of Public Health, Boston, MA
Karin Downs, RN, MPH, Division of Perinatal, Early Childhood and Special Health Needs, Bureau of Family Health and Nutrition, MA Department of Public Health, Boston, MA
Ruth Karacek, RN, MPH, CCM, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA
Background. Global comparisons of maternal mortality rates reveal a US rate far above many developed countries. The highest rates are associated with health and social disparities among poor women of color. The Massachusetts (MA) Mortality and Morbidity Review Study examines the causes pregnancy-associated (PA) deaths, defined as the death of a woman while pregnant or within the first year postpartum. Reviewing PA deaths enables the state to make public health recommendations that address women's health during the childbearing years. We will present epidemiologic analyses, case review findings, and recommendations by the MA Maternal Mortality Review Committee (MMRC).

Methods. We identified PA deaths through case finding strategies including hospital mandatory reporting and vital records data linkage. During 2000-2007, 168 women died during the PA period. We calculated PA mortality ratio (PAMR) overall, by medical and injury causes, and PAMRs and relative risk (RR) for demographic characteristics. The MMRC conducted a qualitative review of medical records. We used the Health Impact Pyramid (Friedan, 2010) to frame MMRC individual, system and community level recommendations.

Results. The overall PAMR was 26.1. Black non-Hispanic (RR: 1.9), younger women (RR: 2.0), women with public insurance (RR: 2.7) or lower education (RR: 2.3) were more likely to die than comparison groups. The MMRC determined that one in five deaths were preventable and developed recommendations that were classified using the 5-tier health impact pyramid.

Conclusions. Using the Health Impact Pyramid to understand health disparities for pregnant and postpartum women provides a framework to improve women's health.

Learning Areas:

Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Describe pregnancy-associated mortality review in Massachusetts. Discuss how the health impact pyramid is a useful framework for addressing social and health disparities related to pregnancy-associated mortality.

Keyword(s): Maternal Health, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the co-investigator of the Massachusetts Maternal Mortality Study at the MA Department of Public Health and responsible for every aspect of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.