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Maternal, Child & Adolescent Health Division

For media inquiries, contact: 

Media@cdph.ca.govā€‹ā€‹ā€‹

The California Pregnancy Mortality Surveillance System (CA-PMSS)ā€‹

Maternā€‹ā€‹al 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 Aā€‹dolescent 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:

ā€‹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 Universityā€™s California Maternal Quality Care Collaborative , and a volunteer review committee of experts.ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹

Key Finā€‹ā€‹dings

  • ā€‹California's rate of increased in 2020 and continued to rise in 2021 during the COVID-19 pandemic.
  • COVID-19 became the leading cause of pregnancy-related mortality in 2019-2021. Before the COVID-19 pandemic, cardiovascular disease was the leading cause of pregnancy-related mortality.
  • The rate of pregnancy-related deaths from infection increased significantly in 2019-2021 compared with prior years. This increase was largely due to the rise in deaths from COVID-19.
  • Racial and ethnic disparities in the rates of pregnancy-related deaths decreased in 2019-2021 but persist. 
  • The disparity in the rates of pregnancy-related deaths by type of health care insurance widened over time and remained wide in 2019-2021.
  • The rate of pregnancy-related deaths was consistently higher for birthing people living in lesshealthy communities than for those living in more healthycommunities. The disparity in the rates for those living in the least healthy communities and those living in the healthiest communities widened in 2019-2021.ā€‹

Data and Statisticsā€‹

Methodologyā€‹ā€‹

Health Equityā€‹ā€‹ā€‹

On the Horā€‹izonā€‹ā€‹ā€‹

Meet the Teaā€‹mā€‹ā€‹

CA-PMā€‹ā€‹SS Team

CDPH MCAH Divisionā€‹

Paula Krakowiak, PhD, MS ā€“ Director of Maternal Mortality Investigations
Dan (Susan) Sun, MA 
Deepika Mathur, MD
Harman Chauhan, PhD, MS, MPH
Kristie Nguyen, MPH
Stephanie Nunes, MPH
Tina Rylee, PhD

CDPH-Appointed

Kimberly D Gregory, MD, MPH ā€“ Pregnancy-Associated Review Committeeā€‹ Chairā€‹

California Maternal Quality Care Collaborative

Christine H. Morton, PhD

Public Health Institute

Christy McCain, MPH

Delphina Alvarez

CA-Pā€‹MSS Review Committee

ā€‹Neeru Gupta, MD, FACOG

The Permanente Medical Group (Northern California Region)ā€‹ ā€‹(Obstetrics & Gynecology)

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)ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹

Malini Nijagal, MD, MPH

University of California, San Francisco

(Obstetrics & Gynecology)ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹

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