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Maternal, Child, and Adolescent Health Division

The California Pregnancy Mortality Surveillance System (CA-PMSS)

Maternal mortality is a key indicator of population health. Deaths in pregnancy and postpartum should be rare events, so routine and accurate surveillance of pregnancy-related deaths is an essential public health responsibility. CA-PMSS is a statewide surveillance of deaths among Californians who were pregnant within the prior year. 

The Maternal, Child and Adolescent Health (MCAH) Division of the California Department of Public Health (CDPH) initiated CA-PMSS in 2018 to provide a timely and accurate accounting of deaths related to or aggravated by the pregnancy or its management. In CA-PMSS, deaths are identified by complex data linkage of vital statistics data and patient-level administrative data from hospitals, emergency departments and ambulatory surgery centers. Coroner and autopsy reports and medical records are used to verify pregnancy status and timing to death. A committee of experts conducts limited case reviews of the deaths to determine the underlying cause of death and whether it was related to pregnancy.

The goal of CA-PMSS is to monitor deaths related to pregnancy using the most accurate information available. While the commonly used maternal mortality ratio (MMR) remains a key indicator of the overall health of a population, it relies solely on death certificate data. CA-PMSS compiles the findings from its more complex data linkage and expert committee review to create a pregnancy-related mortality ratio (PRMR), allowing California to monitor deaths related to pregnancy using the most accurate information available .

Here are the major differences between the two maternal mortality measures:

 

​Funded by the federal Title V Maternal and Child Health Block Grant, CA-PMSS relies on a collaboration with three key partners: The Public Health Institute , Stanford University’s California Maternal Quality Care Collaborative , and a volunteer review committee of experts.​​​​​​​​​

Key Findings

  • California’s rate of pregnancy-related deaths increased in 2020 during the COVID-19 pandemic. In 2020, California’s pregnancy-related mortality ratio was 18.6 deaths per 100,000 live births – a 45% increase compared with the rate of 12.8 in 2019. Deaths from COVID-19 contributed to this rise.
  • The leading causes of pregnancy-related mortality in 2018–2020 were cardiovascular disease, hemorrhage, and infection.
  • The rate of pregnancy-related deaths from hypertensive disorders of pregnancy decreased significantly in 2018–2020 compared with prior years.
  • Racial/ethnic disparities in the rates of pregnancy-related deaths narrowed in 2018–-2020 but persist. The rate for Black birthing people was 3.1 to 3.6 times higher than the rates for Asian, Hispanic/Latina, and White birthing people.
  • Disparities in the rates of pregnancy-related deaths by type of health care insurance widened over time. In 2018–2020, the rate for birthing people with Medi-Cal health coverage was 2.8 times higher than the rate for those with private health insurance.
  • The rate of pregnancy-related deaths was consistently higher for birthing people living in the least advantaged community conditions than for those living in more advantaged community conditions. In 2018–2020, the rate for those living in the least advantaged community conditions was 2.1 times higher than the rate for those living in the most advantaged community conditions.​​

For more details, see the latest CA-PMSS data slides (PPTX) and Pregnancy-Related Mortality Dashboard​. ​​​​​​​​​​​​​​​​​​​

Methodology

Health Equity

On the Horizon

Meet the Team

CA-PMSS Team

CDPH MCAH Division

Paula Krakowiak, PhD, MS – Team Lead
Deepika Mathur, MD

Dan (Susan) Sun, MA ​​
Tina Rylee, PhD

California Maternal Quality Care Collaborative

Christine H. Morton, PhD

Public Health Institute

Christy McCain, MPH

Delphina Alvarez

Cedars-Sinai Medical Center

Kimberly Gregory, MD, MPH – Chair​

CA-PMSS Review Committee

Kimberly Gregory, MD, MPH – Committee Chair

California Maternal Quality Care Collaborative

(Maternal Fetal Medicine)

Maurice Druzin, MD

Stanford University

(Maternal Fetal Medicine)

Afshan Hameed, MD

University of California, Irvine

(Cardiology, Maternal Fetal Medicine)

Thomas Kelly, MD

University of California, San Diego

(Maternal Fetal Medicine)

Natalie Martina, CNM, MSN

Alta Bates Medical Center, Berkeley

(Nurse Midwifery)​​​​

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