This report was completed by the Family Health Outcomes project under an agreement with the Bay Area Data Collaborative (BADC), a collaborations of ten MCAH jurisdictions in the San Francisco Bay Area with funding from the California MCAH Program as part of their Maternal Care Quality Improvement Project. The report addresses the following questions for the period between 2001 and 2006: 1. How many pregnant women age 10-60 were admitted to California hospitals? 2. How many women had an adverse pregnancy outcome or died within 1 year of a pregnancy - related condition? and 3. What differentiated women who had adverse outcomes or died?

Between 2001 to 2006, 3,014,039 California women received pregnancy-related care in hospitals, emergency departments, or ambulatory centers. Compared with other California women, Bay Area residents had different profiles for demographic characteristics, provider characteristics, co-morbid conditions, pregnancy diagnoses and procedures, delivery methods, and outcomes. Bay Area women were more likely to have adverse outcomes but were not more likely to die. Women with mental illness and/or substance abuse (MISA) diagnoses were more likely to have other co-morbid and pregnancy-related complication diagnoses. They also had different delivery patterns and higher rates of adverse outcomes. Women with MISA diagnoses were 6% of the maternal population and 33% of deaths. About 5% of women experienced adverse patient safety outcomes, but half of women who died had one or more of the adverse safety outcomes. Of women who had adverse safety outcomes resulting in death, half had a MISA diagnosis. Consistent with findings of other researchers, the methods used to identify "women" and link them to the death files resulted in doubling California's reported one-year maternal mortality rate. The report evaluates the cost consequences of MISA, adverse outcomes of medical care, and mortality for California's pregnant women.