Cardiovascular issues, such as hypertension, were the most common cause of pregnancy-related deaths in Missouri between 2017 and 2021, according to a report by the state Department of Health and Senior Services.
During that period, for every 100,000 births in the state, more than 32 people died because of pregnancy-related complications within one year — an average of 70 deaths annually.
Many of the 115 new mothers in that five-year period who died of pregnancy-related causes did so more than 43 days after giving birth, said Ashlie Otto, a registered nurse specialist at the DHSS Department of Women’s Health. That could be because a patient may not go to the doctor as frequently after she stops visiting an OB-GYN or loses her insurance coverage, she said.
“A lot of these conditions don't just stop at that six-week mark. Some cardiovascular conditions can take up to six months to kind of go back to baseline or to resolve,” she said. “We do have a gap in connecting those individuals back to a primary care provider or family physician to continue ongoing care.”
Missouri legislators in 2023 passed a law that extended the state’s postpartum Medicaid coverage from its previous 60 days to a year. Otto hopes that change will result in fewer mothers dying.
The latest report is the first that includes the year after the onset of the COVID-19 pandemic.
During the three-year period of a previous report that included the pandemic’s first year, mental health problems became the top cause of pregnancy-related deaths, as more new mothers died of substance use disorder and suicide. Forty-four percent of pregnancy-related suicides over the five-year period covered by the report happened in 2020.
The report was also the first to reflect deaths related to the coronavirus, with a half-dozen new mothers dying from the infection.
The new report shows cardiovascular issues have again overtaken mental health problems as the leading cause of pregnancy-related mortality, Otto said.
“We still had an increased number [of mental health-related deaths] in 2021 than what we had in years past, but we are slowly seeing that number coming down to where we were before the pandemic hit,” she said.
The report also outlined class and race disparities. Pregnancy-related mortality for Black women in the state is 2.5 times the ratio of their white counterparts. People with higher education degrees were less likely to die than those without college diplomas. Those on Medicaid were also more likely to die from pregnancy-related causes.
The review also tabulated pregnancy-associated deaths, which happen in a year after a person gives birth but aren’t directly related to pregnancy.
More than 200 mothers died in the five-year period covered by the report of pregnancy-associated causes. Reviewers could not determine whether 31 deaths were directly related.
More than 200 new mothers died in the year after giving birth due to causes not directly related to their pregnancies.
