Report: Texas' maternal deaths were dramatically lower in 2012 under new methodology

The number of Texas women who died from pregnancy complications in 2012 is being cut by more than half through a new state method for counting and confirming maternal deaths — which made Texas the subject of national news coverage over its high death rate.

Several of the state’s top health experts released a report in the medical journal Obstetrics & Gynecology on Monday  showing that by using the new method, the number of women who died dropped from 147 to 56.

The study uses an enhanced method of counting maternal deaths that involves cross-referencing birth certificates, death certificates, hospital discharge data and medical records to confirm that a woman who died was pregnant before she died. The state’s current method of calculating maternal deaths includes using specific medical codes and requiring officials to check a box on death certificates indicating whether a woman was pregnant before she died.

The study said the state’s 2012 maternal death numbers inflated the number of women 35 and older who were classified as a maternal death and included reporting errors in which women who had not been pregnant were reported as maternal deaths. The researchers said they also found 2012 deaths that were not included in the state's original maternal death numbers. 

The authors noted that other states have used the same methodology to calculate maternal deaths. They said they chose 2012 for the new analysis because it was the year when maternal deaths peaked in  Texas.

The study’s authors said they plan to use the new method to confirm maternal deaths and calculate maternal mortality rates for additional years.

Regardless of the overall numbers, the new study showed that black women in Texas are still at the highest risk of dying during or after their pregnancy. The study found that the rate of black mothers dying during or soon after pregnancy in 2012 was 27.8 per 100,000 live births, compared to 13.6 for white women and 11.5 for Hispanic women.

Lisa Hollier, chairwoman of the state’s Task Force on Maternal Mortality and Morbidity and one of the study’s authors, said part of the group’s mission is to make sure accurate data is being used. She said the new study “illustrates the incredible importance of having the review committee look at all of these cases very carefully.”

Hollier said there’s still a need for health providers and state legislators to focus on how to reduce preventable pregnancy complications from hemorrhaging, high blood pressure, drug overdoses and other causes.

“Even one preventable death is too many, and we owe it to the women and the families that we care for to make childbirth safe,” Hollier said.

In a series published in January, The Texas Tribune found that Texas’ maternal death rate stems from many women’s lack of access to health insurance, prenatal and postpartum care, as well as changes to the state’s women’s health programs and Texas lagging behind other states in implementing maternal health initiatives.

Texas’ maternal mortality data has been the subject of conflicting studies showing a variety of results. The state’s official statistics are different from those compiled by the Centers for Disease Control and Prevention, and researchers have produced their own numbers.

In 2016 Marian MacDorman, a professor at the University of Maryland Population Research Center, released a study in Obstetrics and Gynecology showing that in 2012, 148 Texas women died from pregnancy-related complications, including excessive bleeding, obesity-related heart problems and infection. Two years earlier, 72 women had died from those causes.

MacDorman wrote at the time that “in the absence of war, natural disaster, or severe economic upheaval,” such a rise seemed unlikely. The study made national and international news and raised questions over how Texas was addressing women’s health. 

The state researchers addressed MacDorman’s findings in Monday’s study:  “Given the significant reduction in the maternal mortality ratio when using confirmed maternal deaths, this high estimate reported was likely the result of data error.”

In an editorial released in the same journal Monday, MacDorman wrote that the Texas maternal mortality task force's work is "laudable, necessary, and entirely appropriate given the current state of Texas vital statistics."

But she raised concerns about the new study's scope.

"As the study examined data from only a single year (2012), questions concerning the maternal mortality increase in Texas in the critical period from 2010 to 2012 remain unanswered, as do questions about more recent trends," MacDorman wrote. "In the absence of reliable vital statistics data, answers to those questions depend on detailed case review — an expensive and time-consuming process for committees."

Chris Essig contributed to this report.