Most maternal deaths during or within a year of pregnancy in Louisiana in 2017 could have been avoided, according to a newly released review by the Louisiana Department of Health.
The report, published Thursday, found that among deaths caused in some part by pregnancy, 80 percent could have been prevented. The most common causes of death in that category were cardiovascular and coronary conditions, and those risks were higher for women over 35 years old.
For deaths that occurred within a year of pregnancy but were not directly related to the pregnancy, 90 percent were preventable. The top causes of death were homicide and motor vehicle accidents, and the risks were heightened for those under 25 years old.
The report continued a trend in striking data from the Department of Health revealing stark disparities in maternal health. A previous review of pregnancy-related deaths within 42 days of birth between 2011 and 2016 found that Black women were four times more likely to die than white women.
The 2017 report’s data was even more troubling. For deaths directly related to pregnancy, Black women were five times more likely to die.
“I was not surprised, but I'm disappointed because that speaks to the care that me and my colleagues provide,” said Dr. Veronica Gillispie, an OB-GYN and the medical director for the Louisiana Perinatal Quality Collaborative in the Department of Health and one of the report’s authors.
For all pregnancy-associated deaths, black women were twice as likely to as white women to die. Gillispie cited structural racism, implicit bias among providers, and a lack of continuity of care as key causes of the disparity.
“As many times as I can talk about health equity and the lack thereof, I will take that opportunity,” Gillispie said. “This, again, speaks to the lack of equity and disparities and the fact that we need to put more resources and effort into improving our disparities.”
One finding that did surprise Gillispie was the high number of deaths connected to substance use. The report found that substance use contributed or probably contributed to 1 in 4 deaths that occurred within a year of pregnancy, but weren’t caused by the pregnancy.
The report recommends universal screening for mental health and substance abuse issues for all pregnant people. Gillespie said the findings could also support a shift away from standardized prescription of narcotics for pain experienced from birth and toward more individualized care that could minimize the risks for addiction.
The report reviewed 65 deaths that occurred in 2017. The authors determined that 15 were caused by complications from the pregnancy, and 41 were pregnancy-associated, meaning they occurred within one year of birth. For the remaining nine deaths, the report’s authors couldn’t establish whether the deaths were caused in some part by pregnancy itself. The top cause of death in that category was suicide.
Gillespie noted the data can not be directly compared to the state’s earlier review, because this latest report uses an expanded scope of time — one-year post-birth — that’s in keeping with pregnancy-related deaths as defined by the Centers for Disease Control and Prevention.
Overall, the findings fit within established research showing pregnant and postpartum women face high rates of homicide, and that for those who die from causes directly related to their pregnancy, hypertension is a key factor.
It recommends expanding the collaboration among specialists, especially cardiologists, psychiatric and addiction specialists.
The report will feed the work of the Perinatal Quality Collaborative, which is working with the majority of hospitals in the state to increase training and knowledge of best practices to tackle the state’s high maternal mortality rate.
“We'll use this to continue to inform policy,” Gillespie said, “to continue working with our hospitals, working with community services, so that we can make sure our patients are getting better-coordinated care, and addressing what we know is causing maternal mortality in Louisiana.”