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Jan 11 -- The Centers for Disease Control and Prevention (CDC) invites the general public and other federal agencies to comment on a proposed information collection project titled Maternal Mortality Review Information Application (MMRIA). MMRIA is a standardized data collection system that allows Maternal Mortality Review Committees (MMRCs) to abstract relevant data from a variety of sources, document committee decisions, and analyze data to better understand the contributing factors and preventability of pregnancy-related deaths in order to develop recommendations for prevention. CDC must receive written comments on or before March 13, 2023.

CDC seeks a Revision to continue to collect information through the Maternal Mortality Review Information Application (MMRIA) for three more years. MMRIA is a standardized data collection system that allows Maternal Mortality Review Committees (MMRCs) across the country to abstract relevant data (clinical and non-clinical) from a variety of sources, document committee decisions, and analyze data in order to better understand the contributing factors and preventability of pregnancy-related deaths and thus to develop recommendations for prevention.

Pregnancy-related deaths are defined as a death as a result of pregnancy or delivery complications, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. Considerable racial disparities exist, with persons who are American Indian/Alaska Native and Black persons two to three times more likely to die from pregnancy-related complications than persons who are White. Findings from analyses of aggregated MMRC data indicate that about four out of five pregnancy-related deaths are preventable.

Maternal Mortality Review is a process by which a multidisciplinary committee at the jurisdiction level identifies and reviews cases of death that occur during or within one year of end of pregnancy. Members of MMRCs typically represent public health, obstetrics and gynecology, maternal-fetal medicine, nursing, midwifery, forensic pathology, mental and behavioral health, community-based organizations, and other relevant partners. Through a partnership among the MMRC, state vital records office, and epidemiologists, deaths among females of reproductive age are examined to determine if they occurred during pregnancy or within one year of the end of pregnancy (i.e., pregnancy-associated deaths). Through this process, potential cases of pregnancy-related deaths (i.e., death from any cause related to or aggravated by pregnancy or its management) are then identified. Review committees access multiple sources of clinical and non-clinical information to understand the circumstances surrounding a death in order to determine pregnancy-relatedness and develop recommendations for action to prevent similar deaths in the future.

MMRIA is a standardized data collection system designed to support MMRC processes. Data are abstracted and entered into MMRIA from various sources, including death records, autopsy reports, birth and fetal death records, prenatal care records, emergency department visit records, hospitalization records, records from other medical office visits, medical transport records, social and environmental profiles, mental health profiles, and informant interviews. Case narratives for committee reviews are developed from the abstracted data entered into MMRIA to facilitate committee review, and committee decisions based on their review are also be entered into MMRIA. The data collected in MMRIA is used to facilitate an understanding of the drivers of maternal mortality and complications of pregnancy and associated disparities; determine what interventions at patient, provider, facility, system, and community levels will have the most impact; and implement data driven recommendations.

Forty jurisdictions have funding support through the cooperative agreements Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees (CDC-RFA-DP19-1908) and Preventing Maternal Mortality: Supporting Maternal Mortality Review Committees (CDC-RFA-DP22-2211) which includes 39 direct awardees and one sub-awardee. These jurisdictions are required to compile a defined set of information about pregnancy-related deaths into MMRIA. It is estimated that information will be collected for a total of 1,983 pregnancy-associated deaths on average, annually, among the 40 jurisdictions with funding support through CDC-RFA-DP19-1908 and CDC-RFA-DP22-2211.

There are four changes that result in this request for revision:

-- First, through additional congressional appropriations, an additional 15 jurisdictions are now funding recipients. This represents an increase from 24 to 39 funding recipients. There is a total of 40 respondents, because one funding recipient provides a subaward to an additional respondent.
-- Second, CDC estimates a higher number of pregnancy-associated deaths due to utilizing data from the Pregnancy Mortality Surveillance System (PMSS) rather than CDC WONDER for these estimates. PMSS estimates of pregnancy-associated deaths are more accurate due to more comprehensive and complete identification of these deaths through multiple case identification methods.
-- Third, CDC has been working with the National Association for Public Health Statistics and Information Systems on an initiative that enables CDC to transfer vital records data associated with CDC identified pregnancy-associated deaths directly into a jurisdiction's instance of MMRIA, reducing manual data entry burden for the 17 respondents participating in the initiative.
-- Fourth, to address user identified needs and increase data use for analysis by jurisdictions, a total of 60 new optional fields were added to MMRIA, three fields removed, and two fields combined. None of the added fields are required fields.
 
MMRIA: https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/MMRIA.html
Draft data collection instruments and technical documentation: https://www.dropbox.com/scl/fo/dx8yzo6ilccbc1rtszpvq/h?dl=0&rlkey=3z1oh4y99z4p58qeq5cqjbluk
FRN: https://www.federalregister.gov/d/2023-00334

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