Texas initiates review of maternal mortality cases that occurred during the COVID-19 pandemic


Boram Kim


 The Texas Department of State Health Services (DHSH) confirmed this week it has initiated review of maternal mortality cases from 2020 and into early 2021, spanning the beginning and peak of the COVID-19 pandemic. 


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The Texas Maternal Mortality and Morbidity Review Committee (TMMMRC) is scheduled to conduct its next meeting on September 8th where it will preside over the cases. TMMMRC will expand its membership from 17 to 21 members

While the meeting agenda has yet to be finalized, the data is expected to reveal an increase in statewide pregnancy-related cases attributed to COVID-19, according to TMMMRC member Amy Raines-Milenkov, DrPH, director of the University of North Texas Health Science Center’s Healthy Start program

“[COVID-19] is going to change the reviews—having a more detailed view [of whether] the [cases are] related to COVID because [the patient] had COVID, or perhaps indirectly attributed to COVID.

Across the country, that’s our expectation—that there will be an increase in deaths due to COVID. I think we’ve already seen that, but I think for [TMMMRC], that [higher maternal mortality is] an expectation as well.”

— Raines-Milenkov

Texas has the highest rate of uninsured women of reproductive age (18-44) in the country and nearly half of the 147 maternal deaths reported in the state in 2019 were from pregnancy-related complications. 

Upon the delayed release of its 2022 maternal health report last year, the Department of State Health Services said that beginning in April of 2020, the state’s severe maternal morbidity (SMM) rate rose to 72.7 cases per 10,000 delivery hospitalizations and SMM associated with COVID-19 had a disproportionately high impact on Hispanic women. 

While Raines-Milenkov praised the state’s move to expand Medicaid postpartum coverage for new mothers to 12 months, she said more work needs to be done. 

“Women need care before they become pregnant, to address these concerns before they become pregnant so that it poses less of a risk to themselves and to their newborns when they become pregnant. So in a state like Texas that hasn’t expanded Medicaid, you’re still in the same position.

The better way would be to have expanded Medicaid where women are able to have checkups and get these concerns addressed before they become pregnant. So from a policy perspective, there’s a lot of conditions—diabetes, hypertension, [sexually transmitted diseases or sexually transmitted infections]—that can be addressed prior to pregnancy.”

— Raines-Milenkov

Data from 2019 and early 2020 also showed SMM rates were disproportionately higher for Black women than other racial groups at 117.3 cases per 10,000 hospital deliveries, more than double the rate (56.3 cases per 10,000 deliveries) for white women. 

Obstetric hemorrhage remained the leading cause of SMM and while rates of hemorrhage-related cases decreased for every population tracked in Texas, the rate rose among Black women. 

A recent study has linked hypertensive disorder to adverse pregnancy outcomes such as C-sections, preterm births, and low birth weight. Black people have higher rates of hypertension in America.

Raines-Milenkov said organizations need to have a maternal health equity lens in their approach to caring for expectant Black mothers. 

“[Focusing on Black women is] appropriate—that you put more resources towards those communities that are disproportionately affected by different health conditions. You’re not going to see reductions in what we all want to see in better health outcomes if we don’t specifically focus on the Black community.”

— Raines-Milenkov