Mental health is a top underlying cause of pregnancy-related deaths in Missouri

Mental health conditions and cardiovascular disease are the top two underlying causes of pregnancy-related deaths in Missouri, according to the latest report released by the state Department of Health and Senior Services.

The annual report was released Tuesday evening by the department through a partnership with the state’s Pregnancy-Associated Mortality Review Board. Research reveals that between 2018 and 2022, a total of 350 women died while pregnant or up to a year postpartum.

The highest number of deaths, 85, was in 2020.

Ashlie Otto, a registered nurse specialist at the Missouri Department of Health and Senior Services, has conducted research on the topic with the department for the last 10 years.

She said mental health conditions like postpartum depression and anxiety disorders are a few examples of underlying causes that contributed to deaths and were mostly preventable.

The goal is for women to utilize the report and find resources for a successful pregnancy and beyond, she said.

“I just hope that whenever they look at this report and maybe share this report with others, that they can find someone they trust, so whether it be a provider, a midwife, a doula — maybe a community health worker or maybe it's their pastor that they can talk with about this report (and ask), ‘What should I look for?’ or ‘I have this chronic medical condition, what do you think I need to do ahead of time?’” Otter said.

“Or maybe they know someone who's pregnant and they want to talk with them about the risk factors.”

A pregnancy-related death is one caused by pregnancy or was due to an underlying condition that was exacerbated by the pregnancy, Otter said.

She clarified that underlying causes, like mental health conditions, are not to be confused with direct causes of death.

An example includes depression or bipolar disorder, which may not be included in a toxicology or autopsy report but can stem from pregnancy and play a significant role that ultimately leads to death, she said.

Majority of deaths were preventable

About 80% of the pregnancy-related deaths from 2018 to 2022 could have been prevented, the report found.

Mental health conditions contributed to 34% of the 350 deaths during those five years, and all of those cases were preventable if the right care had been provided, researchers found. Another 34% of overall deaths were due to substance use disorders.

Deaths due to cardiovascular disease happened because high blood pressure wasn't treated or medications weren’t provided quickly enough, Otter added.

In other cases, the individual wasn't able to pay for their high blood pressure medication if they needed to take it long term after delivery.

“Collectively as a state and as communities, we can prevent those things from happening,” Otter said.

Maternal deaths increased nationally during the COVID-19 pandemic in 2020 and 2021. Now, the maternal death rate in Missouri is generally decreasing and appears to be returning to pre-pandemic numbers, but it’s hard to say whether things are truly getting better, Otter said.

“I think it's going to take a couple more years to really see all of the efforts that are going into maternal health in Missouri as we put all of these initiatives in place, if we're really going to see that decline,” Otter said. “And what we really hope to see is no deaths at all.”

Report recommendations include expanding Medicaid coverage, improving community infrastructure and implementing evidence-based practices.

Key takeaways

• An average of 70 women died per year while pregnant or within one year postpartum between 2018 and 2022.

• The pregnancy-related mortality ratio was 32.3 deaths per 100,000 live births.

• The pregnancy-related mortality ratio for Black women was 2.5 times the ratio of white women, but this gap is narrowing compared to the last three maternal mortality reports.

• Discrimination contributed to 18% of deaths.

• All pregnancy-related deaths due to mental health conditions, including substance use disorders, were preventable.

• The PAMR Board determined that 80% of pregnancy-related deaths between 2018 and 2022 were preventable.

• Women living in micropolitan counties had the highest ratio of pregnancy-related deaths, with 38.7 per 100,000 live births.