Maternal Mortality in Missouri: A Comparison of Definitions and Data Sources.

There are multiple surveillance systems working to address the issue of maternal mortality in Missouri. These surveillance systems have key methodological differences in their definitions, terminology, inclusion criteria, and purpose. This study aims to provide an understanding of the practical effects of these programmatic differences regarding what cases are included and how this can impact the interpretations of the data and influence policy decisions. To accomplish this, death certificates identified by the Missouri Vital Statistics program, the Pregnancy Mortality Surveillance System, and the Pregnancy-Associated Mortality Review (PAMR) program were compared. Commonalities and differences were noted, demonstrating the real-world effects of the methodological differences between programs. In particular, the PAMR program includes injury deaths in the count of pregnancy-related deaths, which are not included by other surveillance systems. These differences highlight the importance of understanding the methodology and limitations of a dataset.