The Virginia Maternal Mortality Review Team (MMRT) is proud to present the 2023 Annual Report of statistical data as mandated by Code of Virginia, § 32.1-283.8. This shall be made available to the Governor and the General Assembly by October 1, 2023. This report provides an overview of the patterns and trends in pregnancy-associated deaths in the state of Virginia in 2021. Pregnancy-associated death is defined as “the death of a woman while pregnant or within one year of pregnancy regardless of the outcome of the pregnancy or the cause of death.(*1)" Additionally, this report presents the MMRT determinations of preventability, pregnancy-relatedness, contributors to mortality, and recommendation themes for 2018(*2) pregnancy-associated death cases. The MMRT is dedicated to understanding the circumstances surrounding each of these deaths so that strategies can be developed to reduce maternal mortality across the Commonwealth. The MMRT is an ongoing collaborative effort led by the Virginia Department of Health’s Office of Family Health Services and Office of the Chief Medical Examiner. Data highlights are listed below.

DATA HIGHLIGHTS

1. In the Commonwealth of Virginia, the number of pregnancy-associated deaths decreased from 82 in 2020 to 64 in 2021.

2. The pregnancy-associated death rate decreased from 86.6 per 100,000 in 2020 to 66.9 per 100,000 in 2021.

3. Approximately 33% of these deaths occurred between 43 days and 365 days after the end of the pregnancy.

4. Over 30% of pregnancy-associated deaths involved women ages 35 and older.

a. Pregnancies in birthing persons over the age of 35 are considered high-risk and account for 22.1% of all live births in 2021.

5. Black women continue to experience higher rates of pregnancy-associated deaths when compared to their White counterparts.

6. Black women were more likely to die from cancer and COVID-19 than other races.

7. Statistically, black women were significantly more likely to die by homicide than any other race (p<.01).

8. The rate of pregnancy-associated deaths by suicide decreased from 7.4 per 100,000 live births in 2020 to 3.1 per 100,000 live births in 2021.

9. Approximately 80% of pregnancy-associated accidental deaths were from accidental overdoses.

10. The rate of accidental overdoses decreased from 22.2 per 100,000 live births in 2020 to 11.5 per 100,000 live births in 2021.

11. The Northwestern Health Services Area had the highest rate of pregnancy-associated deaths at 101.1 per 100,000 live births, followed by the Eastern (85.3 per 100,000 live births) and Southwestern (82.7 per 100,000 live births) Health Services Area.

12. Pregnancy-associated death rates were consistently higher in urban areas versus rural areas.
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(*1) Association for Maternal and Child Health Programs. (2022, August 8). Definitions. Retrieved from Review to Action: https://reviewtoaction.org/learn/definitions
(*2) The last completed review cycle of pregnancy-associated death cases that the MMRT has reviewed is 2018. In September of 2022, the Office of the Chief Medical Examiner’s Division of Death prevention received a grant from the Centers for Disease Control and Prevention (CDC) to increase surveillance efforts and create a partnership with the Virginia Neonatal Perinatal Collaborative (VNPC) to further address maternal mortality in Virginia. One of the goals of the grant program is to improve the timeliness of pregnancy-associated death case review. As such, the MMRT moved to begin reviewing cases from 2021. Data from 2019 and 2020 cases will be abstracted and analyzed but will not undergo a full MMRT review.