Over the 14 years of case review, the Virginia Maternal Mortality Review Team noted the significance of chronic diseases in relation to mortality in pregnant women. As such, the Team elected to prepare this report, examining the trends and exploring chronic disease among PADs in Virginia and worked to identify risk factors associated with such deaths. This report focuses on women with chronic diseases (including chronic mental health and substance abuse issues) that died a PAD in Virginia between 1999 and 2012. These deaths include all manners of death (natural, homicide, suicide, accident, and undetermined).