A Missouri review board deemed 79% of the state’s pregnancy-related deaths from 2019 to 2023 preventable, pointing to gaps in postpartum follow-up and mental healthcare.
The finding comes from the Missouri Department of Health and Senior Services’ Pregnancy-Associated Mortality Review Board; its latest five-year report was published in June.
The board reviewed 340 pregnancy-associated deaths — women who died while pregnant or within one year of a pregnancy from any cause — and classified 108 as pregnancy-related, meaning caused by a pregnancy complication, a chain of events set off by the pregnancy or the aggravation of another condition by pregnancy. The 79% preventability rate applies to those 108 deaths.
Missouri averaged 68 pregnancy-associated deaths a year over the period, peaking at 85 in 2020, according to the report.
Cardiovascular disease (23%), mental health conditions (22%) and infection (19%) were the leading underlying causes of pregnancy-related death. The board determined that every death tied to a mental health condition, including substance use disorder, was preventable.
The most frequently cited contributing factor was at the clinician level: an “assessment” failure flagged in 38 cases, including failures to complete Screening, Brief Intervention and Referral to Treatment (SBIRT) for mental health, to work up cardiovascular conditions, and to recognize when a patient needed a higher level of care.
Most deaths did not occur in the delivery room. About 80% of pregnancy-related deaths happened postpartum — 42% within 42 days of the pregnancy’s end and 38% between 43 days and one year after — while 20% occurred during pregnancy.
“Many people mistakenly believe maternal deaths occur primarily during labor,” Sarah Ehrhard Reid, chief of the department’s Office on Women’s Health and the report’s lead author, told NPR. She said the pattern underscores the value of ongoing care beyond the standard six-week postpartum visit.
Disparities also persisted. Black women died at 2.5 times the rate of white women (61.9 versus 25.0 deaths per 100,000 live births), and the mortality ratio among Medicaid enrollees was 2.9 times that of women with private insurance.
Missouri’s toll is higher than the national baseline. Its pregnancy-related mortality ratio of 31.2 deaths per 100,000 live births runs above the CDC’s national ratios between 2019 and 2023, which average 23.2.
The state’s racial gap is somewhat narrower than the country’s: Black women in Missouri died at 2.5 times the rate of white women, versus a national gap in which Black women are more than three times as likely to die of pregnancy-related causes. Neither gap is closing: Missouri’s has held roughly steady across successive reviews, and the national disparity between Black and white mothers has persisted even as the U.S. maternal mortality rate declined in 2023.
The Missouri board recommended adopting Alliance for Innovation on Maternal Health patient safety bundles for conditions such as obstetric hemorrhage, severe hypertension and perinatal mental health; embedding SBIRT screening across prenatal and postpartum visits; and extending Medicaid coverage to one year postpartum.
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