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The Association Between Maternal Mortality, Adverse Childhood Experiences, and Social Determinant of Health: Where is the Evidence?

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Abstract

Introduction

Social determinants of health and adverse childhood experiences have been implicated as driving causes of maternal mortality but the empirical evidence to substantiate those relationships is lacking. We aimed to understand the prevalence and intersection of social determinants of health and adverse childhood experiences among maternal deaths in Colorado based on a review of records obtained for our state’s maternal mortality review committee.

Methods

A 5-member interdisciplinary team adapted the Protocol for Responding to and Assessing Patients’ Assets, Risk, and Experiences and the Adverse Childhood Experiences tools to create a data collection tool. The team reviewed records collected for the purpose of maternal mortality review for pregnancy-associated deaths that occurred in Colorado between 2014 and 2016 (N = 94).

Results

The review identified an overwhelming lack of information regarding social determinants of health or adverse childhood experiences in the records used to review maternal deaths. The most common finding of the social determinants of health was a lack of conclusive evidence in the record (35.1–94.7%). Similarly, the reviewers were unable to make a determination from the available records for 92.1% of adverse childhood experience indicators.

Discussion

The lack of social and contextual information in the records points to challenges of relying on medical records for identification of non-medical causes of maternal mortality. Maternal mortality review committees would be well served to invest in alternative data sources, such as community dashboards and informant interviews, to inform a more comprehensive understanding of causes of maternal mortality.

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Data Availability

De-identified data available through Colorado Department of Public Health and Environment data request process.

Code Availability

Available upon request.

References

  • Andermann, A. (2018). Screening for social determinants of health in clinical care: Moving from the margins to the mainstream. Public Health Reviews, 39(1), 1–17.

    Article  Google Scholar 

  • Callahan, T., Zaharatos, J., Pierre, A., Merkt, P. T., & Goodman, D. (2021). Enhancing reviews and surveillance to eliminate maternal mortality. Journal of Women’s Health, 30(8), 1068–1073.

    Article  Google Scholar 

  • Chasnoff, I. J., Landress, H. J., & Barrett, M. E. (1990). The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County Florida. New England Journal of Medicine, 322(17), 1202–1206.

    Article  CAS  Google Scholar 

  • Che, B., Shen, S., Zhu, Z., Wang, A., Xu, T., Peng, Y., Li, Q., Ju, Z., Geng, D., & Chen, J. (2020). Education level and long-term mortality, recurrent stroke, and cardiovascular events in patients with ischemic stroke. Journal of the American Heart Association, 9(16), e016671.

    Article  CAS  Google Scholar 

  • Clark, S. L., & Belfort, M. A. (2017). The case for a national maternal Mortality review committee. Obstetrics & Gynecology, 130(1), 198–202. https://doi.org/10.1097/aog.0000000000002062

    Article  Google Scholar 

  • Davis, N. L., Smoots, A. N., & Goodman, D. A. (2019). Pregnancy-related deaths: Data from 14 US maternal mortality review committees. Education, 40(36), 2–8.

    Google Scholar 

  • Felitti, V., Anda, R., Nordenberg, D., & Williamson, D. (1998). Adverse childhood experiences and health outcomes in adults: The Ace study. Journal of Family and Consumer Sciences, 90(3), 31.

    Google Scholar 

  • Flanagan, T., Alabaster, A., McCaw, B., Stoller, N., Watson, C., & Young-Wolff, K. C. (2018). Feasibility and acceptability of screening for adverse childhood experiences in prenatal care. Journal of Women’s Health, 27(7), 903–911.

    Article  Google Scholar 

  • Garg, A., Boynton-Jarrett, R., & Dworkin, P. H. (2016). Avoiding the unintended consequences of screening for social determinants of health. JAMA, 316(8), 813–814.

    Article  Google Scholar 

  • Gold, R., Bunce, A., Cowburn, S., Dambrun, K., Dearing, M., Middendorf, M., Mossman, N., Hollombe, C., Mahr, P., & Melgar, G. (2018). Adoption of social determinants of health EHR tools by community health centers. The Annals of Family Medicine, 16(5), 399–407.

    Article  Google Scholar 

  • Gottlieb, L., Tobey, R., Cantor, J., Hessler, D., & Adler, N. E. (2016). Integrating social and medical data to improve population health: Opportunities and barriers. Health Aff (millwood), 35(11), 2116–2123.

    Article  Google Scholar 

  • Henrikson, N. B., Blasi, P. R., Dorsey, C. N., Mettert, K. D., Nguyen, M. B., Walsh-Bailey, C., Macuiba, J., Gottlieb, L. M., & Lewis, C. C. (2019). Psychometric and pragmatic properties of social risk screening tools: A systematic review. American Journal of Preventive Medicine, 57(6), S13–S24. https://doi.org/10.1016/j.amepre.2019.07.012

    Article  PubMed  Google Scholar 

  • Kalter, H. D., Salgado, R., Babille, M., Koffi, A. K., & Black, R. E. (2011). Social autopsy for maternal and child deaths: A comprehensive literature review to examine the concept and the development of the method. Population Health Metrics, 9(1), 45. https://doi.org/10.1186/1478-7954-9-45

    Article  PubMed  PubMed Central  Google Scholar 

  • Kelly-Irving, M., Lepage, B., Dedieu, D., Bartley, M., Blane, D., Grosclaude, P., Lang, T., & Delpierre, C. (2013). Adverse childhood experiences and premature all-cause mortality. European Journal of Epidemiology, 28(9), 721–734.

    Article  Google Scholar 

  • Kramer, M. R., Strahan, A. E., Preslar, J., Zaharatos, J., St Pierre, A., Grant, J. E., Davis, N. L., Goodman, D. A., & Callaghan, W. M. (2019). Changing the conversation: applying a health equity framework to maternal mortality reviews. American Journal of Obstetrics and Gynecology, 221(6), 609.e601-609.e609. https://doi.org/10.1016/j.ajog.2019.08.057

    Article  Google Scholar 

  • Lapp, T. (2000). ACOG addresses psychosocial screening in pregnant women. American Family Physician, 62(12), 2701.

    CAS  PubMed  Google Scholar 

  • Leeners, B., Rath, W., Block, E., Görres, G., & Tschudin, S. (2014). Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences. Journal of Perinatal Medicine, 42(2), 171–178.

    Article  Google Scholar 

  • Logan, E. (1999). The wrong race, committing crime, doing drugs, and maladjusted for motherhood: The nation’s fury over “crack babies.” Social Justice, 26(75), 115–138.

    Google Scholar 

  • Metz, T. D., Rovner, P., Hoffman, M. C., Allshouse, A. A., Beckwith, K. M., & Binswanger, I. A. (2016). Maternal deaths from suicide and overdose in Colorado, 2004–2012. Obstetrics and Gynecology, 128(6), 1233.

    Article  Google Scholar 

  • Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149. https://doi.org/10.1016/j.childyouth.2016.10.021

    Article  Google Scholar 

  • Miller, E. S., Fleming, O., Ekpe, E. E., Grobman, W. A., & Heard-Garris, N. (2021). Association between adverse childhood experiences and adverse pregnancy outcomes. Obstetrics & Gynecology, 138(5), 770–776.

    Article  Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine. (2019). Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health.

  • National Association of Community Health Centers (NACHC), Association of Asian Pacific Community Health Organizations (AAPCHO), Oregon Primary Care Association (OPCA). The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE). Bethesda, MD: NACHC, 2019. Available at: http:// www.nachc.org/prapare.

  • Racine, N., Madigan, S., Plamondon, A., Hetherington, E., McDonald, S., & Tough, S. (2018a). Maternal adverse childhood experiences and antepartum risks: The moderating role of social support. Archives of Women’s Mental Health, 21(6), 663–670.

    Article  Google Scholar 

  • Racine, N. M., Madigan, S. L., Plamondon, A. R., McDonald, S. W., & Tough, S. C. (2018b). Differential associations of adverse childhood experience on maternal health. American Journal of Preventive Medicine, 54(3), 368–375.

    Article  Google Scholar 

  • Racine, N., McDonald, S., Chaput, K., Tough, S., & Madigan, S. (2021). Pathways from maternal adverse childhood experiences to substance use in pregnancy: Findings from the All Our Families cohort. Journal of Women’s Health, 30(12), 1795–1803.

    Article  Google Scholar 

  • Roberts, A. L., Liew, Z., Lyall, K., Ascherio, A., & Weisskopf, M. G. (2018). Association of maternal exposure to childhood abuse with elevated risk for attention deficit hyperactivity disorder in offspring. American Journal of Epidemiology, 187(9), 1896–1906.

    Article  Google Scholar 

  • Schroeder, S. A. (2007). We Can Do Better — Improving the Health of the American People. New England Journal of Medicine, 357(12), 1221–1228. https://doi.org/10.1056/NEJMsa073350

    Article  CAS  PubMed  Google Scholar 

  • Singh, G. K. (2021). Trends and social inequalities in maternal mortality in the United States, 1969–2018. International Journal of Maternal and Child Health and AIDS, 10(1), 29.

    PubMed  Google Scholar 

  • Straton, J. C. (2002). Rule of thumb versus rule of law. Men and Masculinities, 5(1), 103–109.

    Article  Google Scholar 

  • Symonds LeBlanc, S. (2021). Portraying real feelings with comedy on top: Postpartum depression storylines and domestic sitcoms. In M. Johnson & C. J. Olson (Eds.), Normalizing mental illness and neurodiversity in entertainment media: Quieting the madness (pp. 134–148). Taylor & Francis.

    Chapter  Google Scholar 

  • United States Department of Health and Human Service. (2020). Healthy women, healthy pregnancies, healthyfutures: Action plan to improve maternal health in America. https://aspe.hhs.gov/system/files/aspe-files/264076/healthy-women-healthy-pregnancies-healthy-future-action-plan_0.pdf

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Funding

No funding was provided for the enclosed research.

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Authors and Affiliations

  1. University of Colorado Anschutz College of Nursing, 13120 E 19th Ave, Aurora, CO, 80045, USA

    E. Brie Thumm

  2. Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, CO, 80246, USA

    E. Brie Thumm & Rebecca Rees

  3. University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA

    Amy Nacht

  4. Denver Health, University of Colorado School of Medicine, 790 Delaware St., Pavilion C, Denver, CO, 80204, USA

    Kent Heyborne

  5. Obstetrix Medical Group of Colorado, Presbyterian/St. Luke’s and Rose Medical Centers, 2055 High Street Ste 230, Denver, CO, 80205-5503, USA

    Bronwen Kahn

Authors
  1. E. Brie Thumm
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  2. Rebecca Rees
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  3. Amy Nacht
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  4. Kent Heyborne
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  5. Bronwen Kahn
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Contributions

EBT conceptualization, methodology, validation, investigation, writing—original draft, writing—review & editing, visualization, supervision, project administration, RR conceptualization, methodology, validation, formal analysis, data curation writing—original draft, writing—review & editing, visualization, AN conceptualization, methodology, validation, investigation, writing—review & editing, KH conceptualization, methodology, validation, investigation, writing—review & editing, BK conceptualization, methodology, validation, investigation, writing—review & editing.

Corresponding author

Correspondence to E. Brie Thumm.

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Conflict of interest

The authors have no conflicts of interest to report.

Ethical Approval

The enclosed project was determined to not require submission by the Colorado Department of Public Health Institutional Review Board.

Consent to Participate

Not applicable (secondary review of records retained for public health surveillance purposes).

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Not applicable (data de-identified; no images).

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Thumm, E.B., Rees, R., Nacht, A. et al. The Association Between Maternal Mortality, Adverse Childhood Experiences, and Social Determinant of Health: Where is the Evidence?. Matern Child Health J 26, 2169–2178 (2022). https://doi.org/10.1007/s10995-022-03509-z

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  • DOI: https://doi.org/10.1007/s10995-022-03509-z

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