A Learning Health System Approach to Developing a Perinatal Safety Framework and Guide to Reduce Disparities in Maternal Harm.

Introduction: Maternal harm disproportionately affects Black birthing individuals, with systemic and provider-related factors contributing significantly to preventable severe maternal morbidity (SMM) and maternal mortality. Despite the severity of the crisis, traditional maternal safety approaches, which typically exclude patient voices, narrowly focus on severe harm events rather than conducting full-spectrum safety surveillance, which limits proactive intervention strategies. Methods: This study applied the National Academies of Medicine's Learning Health System (LHS) principles to develop a comprehensive maternal safety framework. We employed a mixed-methods approach integrating patient-reported experiences of cases (patients experiencing severe maternal morbidity and/or postpartum readmission) and controls, provider perspectives, clinical informatics, natural language processing of clinical notes, and chart reviews to identify factors contributing to and mitigating maternal harm. We convened an interdisciplinary expert panel to synthesize findings into actionable recommendations for a Perinatal Safety Framework and a Perinatal Strategy Guide. Results: The Perinatal Maternal Safety Framework was developed to define the maternal safety continuum. Six key features emerged, including: (1) three distinct starting points (pregnancy, birth, postpartum), (2) variability in baseline circumstances, (3) a broad definition of maternal harm encompassing physical, emotional, and psychological factors, (4) adaptation of established safety models, (5) six categories of contributing and mitigating factors, and (6) status factors influencing maternal safety outcomes. The Perinatal Strategy Guide outlines evidence-based strategies addressing structural and systemic factors affecting maternal safety. Conclusions: A comprehensive maternal safety framework integrating full-spectrum safety surveillance and patient-centered reporting is critical to addressing maternal health disparities. By applying LHS principles, this study provides a data-driven, equity-focused approach to improving maternal safety. Implementation of the Perinatal Strategy Guide will require interdisciplinary collaboration and engagement of individuals with lived experience to drive systemic change.