Abstract
OBJECTIVE: This study describes the ten-year evolution of Delaware's Maternal Mortality Review (MMR) and key findings over two five-year periods of review: 2015-2019 and 2020-2024. METHODS: This retrospective study describes the causes of death, key characteristics and priority recommendations documented in pregnancy associated deaths reviewed by the MMR Committee between 2015 and 2024. A pregnancy associated death is defined as the death of a Delaware resident while pregnant, or up to one year after the end of pregnancy, from any cause. RESULTS: In the ten-year time period from 2015 to 2024, 75 cases were fully reviewed by the Delaware MMR Committee. Due to better case identification processes with the addition of vital statistics linkage in 2017, 58% more cases were identified and brought before the Committee in 2020-2024 compared to 2015-2019. Thirty-four percent and 20% of cases were determined to be pregnancy related in 2015-2019 and 2020-2024, respectively. A pregnancy related case is one in which the person's death is causally linked in some way to her being pregnant. Most pregnancy related cases occurred in the early postpartum period, within 42 days of delivery. In contrast, most pregnancy associated but not related cases occurred in the late postpartum period, months after delivery. Overdose was the single most common cause of death reviewed by the MMR Committee, most often representing the intersection of mental health conditions and substance use disorder. CONCLUSION: Recommendations put forth by the MMR Committee focus on implementing evidence-based standards and coordinated care across physical health, behavioral health and social domains. POLICY IMPLICATIONS: MMR is a key public health program that provides the most in-depth, comprehensive source of information on the drivers of maternal mortality in the state and its associated risk factors.