Mental health increasingly plays role in Missouri maternal deaths, report finds

In a state with one of the nation’s highest maternal mortality rates, mental health conditions are increasingly playing a role in the deaths, a Missouri state health board found in a report released Thursday.

The state’s Pregnancy-Associated Mortality Review board said mental health conditions were the underlying cause in half of pregnancy-related deaths in 2018, the latest year for which data is available. The year prior, the leading underlying cause in pregnancy-related deaths was cardiomyopathy, a disease of the heart muscle that makes it difficult to pump blood through the body.

The report did not specify which conditions fall under the “mental health” category, but mentioned postpartum depression, which affects one in seven women. The authors categorized addiction separately from mental health conditions.

Racial disparities remained stark. Black women were four times more likely to die a pregnancy-related death than white women.

Thursday’s report was only the second since 2019, when the General Assembly tasked the health department and a board of 18 state-appointed medical specialists to produce an annual assessment. It analyzes all cases in a year of women who died during pregnancy or within one year of giving birth. The directive was prompted as the issue of maternal mortality gained nationwide attention. Gov. Mike Parson in 2018 called for a bipartisan solution.

Missouri receives a grant from the Centers for Disease Control and Prevention to reduce maternal deaths, which occur at a rate of 33 per 100,000 births. It ranked 42nd in the nation in 2018, and if the state were a country, would be 111th internationally, The Star has reported.

The report analyzed fatalities that occurred three years prior because of delays in accessing death records, which are finalized in the year after they occur, according to Department of Health and Senior Services spokeswoman Lisa Cox.

The report was released the week lawmakers, in special session on Medicaid funding, debated blocking the state health program for the poor from covering reproductive health care at Planned Parenthood. Health advocates argued the move would reduce options for low-income women to get health screenings related to pregnancy.

“My concern is really that women aren’t getting adequate pre-conception health,” said Kelly Gorman, a Kansas City OB/GYN who said she specializes in high-risk pregnancies.

In 2018, 68 women died during pregnancy or within a year of birth, according to the report. Twenty-four of those could be attributed to the pregnancy itself, the report said.

The remainder, where the cause is unrelated to the pregnancy, are considered “pregnancy-associated.” Most of those deaths were due to accidents, of which the majority were overdoses. Women on Medicaid were four times more likely to die in pregnancy-associated deaths than women with private insurance.

The legislature in 2018 passed a law extending Medicaid coverage for women to get substance abuse treatment for up to 14 months after giving birth. Former health director Randall Williams has said drug addiction is a significant factor in indirect maternal deaths as the stress of having a newborn makes women more prone to relapse.

But one of the review board’s recommendations, both last year and this year, was extension of Medicaid coverage to women for all conditions in the year after giving birth.

A voter-approved expansion of Medicaid eligibility to adults making up to 138% of the federal poverty level would have accomplished that. But its future is uncertain after Parson canceled its implementation. Medicaid advocates appealed a Cole County judge’s ruling favor of the state last month in a lawsuit to force the expansion, and a hearing in the matter before the Missouri Supreme Court is scheduled for July 13.

Currently, pregnant women earning up to 196% of the poverty level— a little over $25,000 a year for an individual — can get Medicaid coverage, which they lose 60 days after giving birth.

The report also recommended Missouri lawmakers pay for a “consult center” for women to get mental health and substance abuse treatment in the time immediately before and after giving birth.