Farewell frost!
October 30, 2024
A new study from Northwestern Medicine reveals a troubling rise in severe maternal health issues and birth complications in Illinois from 2016 to 2023, closely linked to increases in chronic health conditions affecting pregnancy, such as high blood pressure, gestational diabetes, mental health disorders and especially obesity, which saw the largest increase in annual rates.
The study highlights significant racial and socioeconomic disparities, finding that non-Hispanic Black mothers faced more than double the rate of severe complications compared to non-Hispanic white mothers, and that living in high-poverty neighborhoods elevated maternal health risks across all racial groups.
“Despite significant recent statewide quality-improvement efforts, these birth outcomes are worsening for all ages, reflecting the worsening pre-pregnancy health of the reproductive-age population in Illinois,” said corresponding author Dr. Mugdha Mokashi, a resident physician in obstetrics and gynecology at the McGaw Medical Center at Northwestern.
The findings reflect national trends demonstrating the increasing prevalence of chronic health conditions among pregnant people of all ages, she added. The study, published in the journal Obstetrics & Gynecology Open, provides the most updated data on maternal morbidity and delivery complications within the state of Illinois.
“Our findings underscore the role of social determinants of health — such as race and income — in driving disparities in maternal health, suggesting that efforts to reduce maternal morbidity need to address both racial inequalities and economic hardship,” said study co-author Dr. Lynn Yee, associate professor of obstetrics and pulmonology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine maternal fetal medicine physician.
What they found
In the study cohort of 988,480 births at 127 Illinois hospitals between January 2016 to June 2023, the overall rate of severe maternal morbidity rose from 1.4% in 2016 to 2% in 2023. Non-Hispanic Black patients had more than double the severe maternal morbidity rate (2.6%) compared to non-Hispanic white patients (1.1%). Vaginal birth complications increased 22.4%, and cesarean birth complications increased 48.9%.
Hypertensive disorders of pregnancy and anemia — both of which increased over the study period — were significant risk factors for severe maternal morbidity and birth complications. The largest increase in chronic health conditions by far was in annual rates of obesity, which climbed from 7.8% to 22.3%,
Health counseling before pregnancy is important
Those thinking about pregnancy should be sure to check in with their health care provider for screening for chronic conditions before getting pregnant, the study authors said.
“Pre-conception counseling is such an important way to make sure that all of your health conditions are optimized prior to pregnancy,” Mokashi said, adding that it can also be a way to learn more about important policy and public health initiatives in Illinois.
‘It’s not just because the people getting pregnant are older’
The scientists did additional analysis that found the increased prevalence of maternal health issues and birth complications is not simply because the people getting pregnant are older. Even among those giving birth under age 30, the findings reflected an increase in hypertensive disorders of pregnancy, gestational diabetes, anemia, depression, serious mental illness and other chronic conditions.
“In brief, even young pregnant patients have more medical conditions and complications in pregnancy,” Mokashi said.
What can be done?
Policies for poverty alleviation — such as the proposed refundable child tax credit in Illinois, House Bill 4917, if passed — have demonstrated improvement in maternal health, the study authors said. The Illinois Perinatal Quality Collaborative is also working to reduce cesarean births and address racial disparities through Promoting Vaginal Birth and Birth Equity initiatives.
Increasing access to doula support and patient navigator programs could also be useful supports, Mokashi said. In 2024, the Illinois Department of Healthcare and Family Services adjusted reimbursement for doula services. At Northwestern, research on patient-navigator programs have shown promise in reducing care disparities for low-income minoritized patients postpartum. And at the federal level, passage of the 13 bills comprising the Black Maternal Health Momnibus Act re-introduced in 2023 would provide critical funding support to increase data collection and quality initiatives for prevention of maternal morbidity.
