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Every year, tens of thousands of American women need emergency treatment to save their lives during childbirth or immediately afterwards. A new study shows how their life-threatening risk of childbirth depends on their racial and ethnic origins and their underlying health status.
In total, 1.6% of women have experienced such a situation. Women of color and those of Hispanic origin had higher rates of serious birth-related health problems than non-Hispanic white women – even though they were otherwise healthy.
Non-Hispanic black women accounted for the largest gap, with a 70% higher rate of birth problems than non-Hispanic white women.
Women of all races and ethnic origins who had a health problem such as asthma, diabetes, depression, or substance abuse problems prior to delivery were also at higher risk of problems. severe after childbirth. Women of color or Hispanic origin who had two or more of these conditions were two to three times more likely to have serious birth problems.
The new study, published in the journal Obstetrics and Gynecology by a team from the University of Michigan, sheds a detailed light on the issue of what doctors call a serious maternal morbidity.
Shine the spotlight
Deaths among new mothers have drawn public attention in recent years, notes lead author, Lindsay Admon, MD, M.Sc. But much less data is available on the much more common problem of birth problems that could have killed the mother if emergency care had not been given.
The new study focuses on 10 types of maternal morbidity. Blood transfusions, used mainly in women with severe bleeding, were the most common. They accounted for three-quarters of cases and most of the racial disparity.
"Situations like these are often seen as near-misses, and allow them to get a better idea of who the really high-risk women are," said Admon, an obstetrician of the Von Voigtlander Women & # 39; s Michigan Medicine Hospital. Institute for Health Policy and Innovation.
"Personalities like Serena Williams, who have publicly told of their birth emergencies, have drawn national attention to the urgent need to reduce racial and ethnic disparities in the care of women at the present time. delivery, we need specific measures like this. "
The results are also important for health policy, as many births are funded by Medicaid, with the help of public and federal funds.
In fact, the new study shows that Medicaid paid nearly two-thirds of all births among non-Hispanic Black, Hispanic and Native American / Alaska Indian women, and more than one-third of all births among women non-Hispanic whites and those of Asian / Pacific Island origin.
Learn more about the study
The researchers used national anonymous data on hospital stays from 2012 to 2015, during which 40,873 women who gave birth underwent an emergency procedure or were diagnosed with an emergency. fatal illness.
When calculating their rates of severe maternal morbidity, researchers adjusted factors such as age, income, source of insurance and rural / urban status, which have already been highlighted. to play a role in the outcome of the birth. They were not able to adapt to maternal obesity, another known risk to the health of pregnant mothers.
The study data come from the national sample of inpatients compiled by the Project on Costs and Utilization of Health Care, which is part of the Federal Agency for Research. and the quality of health care.
Admon and her colleagues, whose lead author Vanessa Dalton, MD, MPH, note that this data source allowed them to examine serious maternal morbidity in different racial and ethnic groups, including Native Americans and non-Native Americans. Native Alaska, for which few national data were available. .
In total, researchers examined data from more than 2.5 million birth-related hospitalizations over a four-year period – a representative sample of nearly 13.5 million total births occurring in the country of 2012 to 2015.
This allowed them to calculate severe maternal morbidity rates among women of different origins and status. For example, they found that 231 out of 1000 births among non-Hispanic black women were at the root of one of the serious problems, compared with 139 out of 10,000 among non-Hispanic white women.
If rates were applied to the entire population of women who had babies in the United States from 2012 to 2015, more than 218,000 of them would have suffered from a life-threatening problem.
In addition to blood transfusions, they compiled the rates of blood clotting disorders, heart failure, hysterectomy during or after delivery, acute pulmonary problems, renal failure, eclampsia (seizures due to high blood pressure), shock and sepsis. Disparities between whites and blacks from non-Hispanic backgrounds also appeared under these non-transfusional conditions: 50.5 black mothers out of 10,000 suffered from this, compared to 40.9 out of 10,000 white mothers.
The researchers focused on chronic health problems that, according to previous research, could increase the risk of difficult childbirth. These included diabetes, chronic high blood pressure, chronic lung diseases such as asthma, chronic heart or kidney disease, lupus, pulmonary hypertension, HIV / AIDS, depression and disorders related to the use of substances.
Non-Hispanic white women overall had higher rates of depression and substance use disorders compared to women in any other group. Even so, the risk that a white woman suffering from depression or substance abuse problems experiencing a severe birth problem was significantly lower than the risk incurred by a woman of color suffering from depression or substance abuse problems.
Next steps
"Taken together, our findings shed light on women of color as a high-risk population for each of the problems examined occurring during and immediately after delivery," said Admon. "Women of color who have multiple health problems prior to the birth of their baby appear to be experiencing a" double whammy "effect, which should require us to think about how to structure care to better serve these women vulnerable, not only during pregnancy, but also before and after giving birth too. "
Targeting this effort in health facilities that deal with higher percentages of women of color should be a priority, she says. She also hopes to do more research on the long-term health of newly-delivered mothers, beyond initial hospitalization at birth, to understand trends in health emergencies or "near-misses" during pregnancy. first year after birth.
Admon adds, "By taking care of pregnant women, it's really heartbreaking to see women who start their pregnancy or give birth in a state of health that you know could have been optimized, such as high A1C levels in diabetes, a uncontrolled asthma or substance abuse disorders. This is partly due to the underlying disparities in access to pre-pregnancy care, which also need to be corrected to ultimately reduce serious maternal morbidity and mortality in the United States. "
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