(Getty Images)
Mental health and substance use disorder continue to be common contributing factors in the death of pregnant and postpartum women in Nevada, concludes a new report released by the state’s maternal mortality review committee.
There were 181 pregnancy-associated deaths in Nevada from 2018 to 2023, according to the MMRC. Pregnancy-associated deaths are defined as death by any cause while pregnant or within one year of the end of a pregnancy.
In 2022 and 2023, 55 pregnancy-associated deaths occurred in Nevada. When broken down by causes of death: 13 were considered non-transport accidents, a classification that can include drug overdoses, and 12 were caused by a pregnancy complication or a chain of events initiated by pregnancy. Other causes of death included heart disease (6 deaths), transport accidents (5), homicide (5), and suicide (4).
Mirroring national trends, non-Hispanic Black Nevadans had the highest pregnancy-associated death ratio over the 2-year period–approximately 3.7 times higher than the next highest group (non-Hispanic white).
The top causes of pregnancy-associated deaths varied by race and ethnicity. For non-Hispanic white Nevadans, non-transport accidents were the leading cause. For non-Hispanic Black Nevadans, heart disease was. For Hispanic Nevadans, pregnancy was.
In addition to compiling data on the broad category of pregnancy-associated death, the committee has done a deep dive into 39 pregnancy-associated deaths since it was established in 2020.
In 24 of those cases the cause of death was classified as not pregnancy-related, and an additional four cases could not be conclusively deemed pregnancy-related or not. Eleven were considered pregnancy-related.
Reviewers determined that substance use disorder contributed to 15 of the deaths and “probably” contributed to three others. In 12 cases, there was a history of substance use treatment.
Other social or emotional stressors were also identified by reviewers. In 21 of the cases, child protective services was involved. In 17 cases, there was a history of domestic violence. In 10 cases, there was history of prior suicide attempts.
Report recommendations
The U.S. Centers for Disease Control and Prevention believes that 80% of pregnancy-related deaths are preventable.
The Nevada MMRC report praised legislation passed by state lawmakers in 2023 expanding postpartum Medicaid coverage to 365 days after delivery. Reviewers believe that extended postpartum coverage might have been life-changing for at least one patient whose death was reviewed by the committee.
The new MMRC report lists dozens of recommendations, some which could be implemented by medical practitioners and others that would likely require state action to implement.
Many of the recommendations listed were suggested by the committee in its prior report two years ago, including the need for the state to prioritize access to mental health and medication-assisted substance use treatment for pregnant and postpartum women.
Medicaid covers more than half of all births in Nevada, and data compiled by the MMRC showed the majority of pregnancy-associated deaths in 2022 and 2023 were associated with a Medicaid-covered birth. The MMRC recommends Medicaid provide “acceptable and timely transportation” for health care needs and contract with rehabilitation facilities to ensure every community across the state has a facility that accepts Medicaid.
The MMRC also recommends the formal regulation of naturopaths and holistic physicians to ensure they offer evidence-based treatments in addition to alternatives.
“The evidence supports a dramatically increased mortality rate for those that chose to not treat with evidence-based methods and rely on holistic/natural ones solely,” it reads.
Other recommendations:
- Make the overdose reversal medication naloxone–often known by the brand name Narcan–widely available.
- Formalize through legislation the regulation of kratom, which the Nevada Board of Pharmacy approved as a controlled substance.
- Implement more programs for free medication-assisted substance use treatment in order to reduce the use of kratom for self-treatment of opioid use disorder.
- Directing high-risk patients to providers through direct “warm hand-offs” rather than simply providing a handout with contact information.
- Addressing mental health care provider shortage.
- Investing in low-income housing.
The report notes Nevada is one of two states without a perinatal quality collaborative (PQC), which typically complements the work of maternal mortality review committees and focuses on the implementation of policies that address identified issues. The MMRC report “strongly supports” the creation of a PQC in Nevada to help implement these recommendations.