University of Colorado Anschutz College of Nursing, 13120 E 19th Ave, Aurora, CO, 80045, USA.
Colorado Department of Public Health and Environment, 4300 Cherry Creek S Dr, Denver, CO, 80246, USA.
Matern Child Health J. 2022 Nov;26(11):2169-2178. doi: 10.1007/s10995-022-03509-z. Epub 2022 Sep 30.
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.
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).
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.
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.
健康的社会决定因素和不良的儿童经历被认为是导致孕产妇死亡的主要原因，但缺乏证实这些关系的实证证据。我们旨在根据我们州的孕产妇死亡率审查委员会获得的记录，了解科罗拉多州孕产妇死亡中健康的社会决定因素和不良儿童经历的流行情况和交叉情况。
一个由 5 名跨学科成员组成的团队改编了响应和评估患者资产、风险和经验的协议以及不良儿童经历的工具，以创建一个数据收集工具。该团队审查了为 2014 年至 2016 年期间在科罗拉多州发生的与怀孕相关的死亡而收集的孕产妇死亡率审查记录（N=94）。
审查发现，在用于审查孕产妇死亡的记录中，关于健康的社会决定因素或不良儿童经历的信息严重缺乏。健康的社会决定因素最常见的发现是记录中缺乏确凿的证据（35.1-94.7%）。同样，审查员无法根据现有记录确定 92.1%的不良儿童经历指标。
记录中缺乏社会和背景信息表明，依靠医疗记录来确定孕产妇死亡的非医疗原因存在挑战。孕产妇死亡率审查委员会最好投资于替代数据源，例如社区仪表板和信息提供者访谈，以更全面地了解孕产妇死亡的原因。
