New Data Refutes Inflated Texas Maternal Mortality Rate

After a 2016 publication asserted a dramatic increase in the number of maternal deaths in Texas from 2010 to 2012, DSHS developed a rigorous method to verify maternal deaths, beginning with 2012, and…

A new study by researchers at the Texas Department of State Health Services has found the number of maternal deaths in Texas in 2012 was actually less than half the number previously reported. The peer-reviewed research, published in the journal Obstetrics & Gynecology, determined there were 56 maternal deaths among Texas residents compared with 147 reported in national statistics.

After a 2016 publication asserted a dramatic increase in the number of maternal deaths in Texas from 2010 to 2012, DSHS developed a rigorous method to verify maternal deaths, beginning with 2012, and will continue to use it to find more accurate maternal death counts for additional years.

The study shows dozens of women were identified on their death certificates as being pregnant at the time of their deaths, when they were not. The misclassification most likely occurred because people certifying the deaths selected the wrong pregnancy option in the electronic system used to register deaths.

That may have become a bigger issue between 2010 and 2012 as the proportion of death certificates submitted electronically in Texas increased by more than 40 percent.

“Other academic research has shown issues with the as shown issues shquality of death data, nationally,” said Sonia Baeva, DSHS maternal mortality and morbidity epidemiologist and the study’s lead author. “Death data can be a rich source of information, but our work shows that identification of rare events, such as maternal deaths, should be supported with additional evidence.”

The standard method of calculating maternal deaths relies solely on cause of death codes from death certificates. The enhanced method used by DSHS verifies those deaths by matching them to records of births and fetal deaths and by reviewing medical and autopsy records for any evidence of pregnancy, including miscarriage.

Researchers also identified some maternal deaths missed by the standard method by matching the death records of all female Texas residents against birth and fetal death records.

“This more accurate, verified data is an important part of our ongoing work to improve maternal health in Texas,” said Dr. Manda Hall, DSHS Associate Commissioner for Community Health Improvement. “Better data will improve our ability to implement and assess ways to reduce maternal deaths and other severe pregnancy complications.”

Maternal mortality has been a priority for the Texas Legislature since it established the Texas Maternal Mortality and Morbidity Task Force in 2013.

DSHS continues its efforts to reduce the number of maternal deaths by supporting the work of the task force, rallying hospitals to implement best practices to reduce pregnancy complications, joining other states to develop new guidelines for treating opioid use in pregnancy, and encouraging parents-to-be to improve their preconception health.

The agency is also implementing legislation aimed at improving the quality of death data by developing best practices for investigating and reporting maternal deaths and creating new training for medical certifiers like doctors, justices of the peace and medical examiners.

A new registration system being developed will prompt certifiers to confirm the pregnancy status before allowing a death record to be submitted.

A copy of the study, “Identifying Maternal Deaths in Texas Using an Enhanced Method,” is available from communications@acog.org.