President's Message JNMA FEB 2020 Mothers Dying, Babies Crying

The National Center on Heal Statistics (NCHS) uses the World Health Organization (WHO) definition for maternal mortality: deaths of women while pregnant or within 42 days of being pregnant, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (i.e., neither caused nor complicated by the woman being pregnant at the time of or within 1 year of death).5 In 2018, 658 women were identified as having died of maternal causes in the United States,5 205 of which were Black, with an overall US maternal mortality rate of 17.4 deaths per 100,000 live births. Black women are more likely to die than White women and have higher case-fatality rates from a range of conditions, though the leading causes of maternal death for black and white women are similar.7 Cardiovascular conditions, cardiomyopathy and other medical conditions contributed to 40.9% among White but 46.8% of pregnancy-related deaths for Black women.7 A recent study examining preconception risk factors associated with adverse birth outcomes (including obesity, at-risk drinking, smoking, diabetes, and frequent mental distress) found that the majority of women (52%) had at least one risk factor and nearly 20% had two or more risk factors.8 These conditions are more prevalent in Black women. The North Carolina Division of Health implemented a program called the Pregnancy Medical Home, for low-income pregnant women in 2011. The program has received attention because of the declines in Black maternal mortality rates in the state.16 CMS is this evaluating this model of prenatal care at a number of sites across the country.