A startling data point that showed Texas had the highest maternal mortality rate in 2012 and prompted increased legislative focus on the issue last year was actually incorrect, according to a study published Monday.



A 2016 study published in the medical journal Obstetrics and Gynecology said that in 2012, Texas reported 147 women who died from pregnancy-related causes. The same journal on Monday released a new study by Texas Department of State Health Services researchers who say the number of maternal deaths was much lower 56.



"Other academic research has shown issues with the quality of death data, nationally," said Sonia Baeva, the state department's maternal mortality and morbidity epidemiologist and the study's lead author, in a news release. "Death data can be a rich source of information, but our work shows that identification of rare events, such as maternal deaths, should be supported with additional evidence."



The cause for the discrepancy, according to the department, was likely mistakes made by doctors, justices of the peace and medical examiners, who incorrectly reported in the state's electronic death registration system that some women were pregnant at the time of their death, even though they weren't. The "pregnant at the time of death" option is directly below the "not pregnant within the past year" option in the dropdown list.



The electronic system is operated by the Texas Department of State Health Services, which maintains death records. During that time the percent of death certificates filed electronically increased from 63 percent to 91 percent between 2010 and 2012, which could have contributed to the misreporting, according to the department.



After reviewing birth and death certificates and medical and autopsy records, researchers found that only 47 of the 147 women in the 2016 report died of pregnancy-related causes and found another nine deaths that were not originally counted.



In 2012, the rate was actually 14.6 maternal deaths per 100,000 live births, researchers say, instead of the 38.4 percent that was originally reported. The updated figure puts Texas more in line with rates seen in other states.



Because of the high maternal mortality rate seen in 2012, Texas lawmakers created the state Maternal Mortality and Morbidity Task Force in 2013 and on the heels of the 2016 study, lawmakers extended the task force until 2023 during last year's special legislative session.



"It is clear that Texas does not have the worst maternal mortality in the developed world and that previous reports were grossly inaccurate," said state Sen. Lois Kolkhorst, R-Brenham, who authored the bill to extend the maternal mortality task force. "I believe we, as a state, can and are doing more to improve maternal health outcomes."



The 2016 study couldn't pinpoint the cause of the sudden maternal mortality spike in 2012, especially when Texas had seen a modest increase between 2000 and 2010. The maternal mortality rate in 2010 was 18.8 deaths per 100,000 live births.



Marian MacDorman, the lead author of the 2016 study and researcher at the University of Maryland, said the latest study shows the need for a more accurate national clearinghouse for such data.



"The work of the Texas maternal mortality review committee is laudable, necessary, and entirely appropriate given the current state of Texas vital statistics data. It is also true that, if the vital statistics system were functioning as it should, such a study would not have been needed, because this system would have supplied accurate baseline counts of maternal deaths needed for the committee to begin its work," she and fellow researchers said in an editorial also published Monday in the Obstetrics and Gynecology journal.



Department officials plan on examining maternal mortality rates in 2010, 2013 and 2014, which also saw high numbers. They will also launch an updated death registration system next year to include an extra step where users will have to verify that a woman was pregnant at the time of her death.



Although she agrees with the latest finding of the lower maternal mortality rate, Lisa Hollier, head of the state maternal mortality task force and medical director of obstetrics and gynecology at Texas Children's Hospital said that more still needs to be done to reduce the number of pregnancy-related deaths, especially among African-American women, who are disproportionately affected by the issue.



Common complications related to childbirth include hemorrhaging, chronic issues like high blood pressure and drug overdoses.



"We will continue to do our detailed evaluation of maternal death cases to identify interventions that we can use to prevent maternal deaths and severe complications," Hollier said. "That's another important piece that recognizing that severe complications are far more frequent than maternal deaths and also in many cases preventable."



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