{"id":607,"date":"2024-03-14T12:04:50","date_gmt":"2024-03-14T12:04:50","guid":{"rendered":"https:\/\/retirednurseblog.com\/index.php\/2024\/03\/14\/new-study-challenges-scale-of-maternal-health-crisis-in-the-us\/"},"modified":"2024-03-14T12:04:50","modified_gmt":"2024-03-14T12:04:50","slug":"new-study-challenges-scale-of-maternal-health-crisis-in-the-us","status":"publish","type":"post","link":"https:\/\/retirednurseblog.com\/index.php\/2024\/03\/14\/new-study-challenges-scale-of-maternal-health-crisis-in-the-us\/","title":{"rendered":"New study challenges scale of maternal health crisis in the US"},"content":{"rendered":"
\n

Hundreds of women in the United States die from complications related to pregnancy, childbirth and the time after giving birth\u00a0each year, and the country\u2019s high maternal death rate makes it an outlier among developed nations. <\/p>\n

Federal data shows that maternal mortality has surged in the US in recent years, especially during the Covid-19 pandemic, and experts have expressed concern that the problem is getting worse. In 2022, the Biden administration launched a plan to address the maternal health crisis facing the nation, highlighting that pregnancy and childbirth are \u201ctraumatic experiences\u201d for many and the \u201cpreventable deaths, life-altering complications, and untreated mental health and substance use disorders\u201d that have persisted. <\/p>\n

But a new study suggests that maternal mortality rates in the US may be lower and more stable than federal data suggests \u2013 though still very high. <\/p>\n

Using a \u2018definition-based approach\u2019<\/h2>\n

In 2003, in an effort to better track and understand maternal mortality in the US, the National Center for Health Statistics \u2013 part of the US Centers for Disease Control and Prevention \u2013 requested that states add a \u201cpregnancy checkbox\u201d to death certificates to indicate whether a deceased woman was pregnant at or around her time of death. <\/p>\n

An analysis that prompted the strategy suggested that about 30% of pregnancy-related deaths were being missed before the introduction of the checkbox. By 2018, all 50 states had implemented this change on death certificates. <\/p>\n

In a new study, published Wednesday in the American Journal of Obstetrics and Gynecology, a group of researchers \u2013 from the University of British Columbia in Canada and other institutions around the world \u2013 conducted an in-depth analysis of mortality and natality files recorded by the National Center for Health Statistics from 1999 to 2021. <\/p>\n

Their findings suggest that reliance on the pregnancy checkbox may have led to an increase in misclassified maternal deaths, resulting in an overestimation of maternal mortality and trends over the past few decades in the US. <\/p>\n

\u201cThe pregnancy checkbox was introduced as a means to correct the underestimation of maternal mortality, but we\u2019ve gone from a 30% underestimation to like a 300% increase in maternal mortality rate, which is a substantial overestimation,\u201d said Dr. KS Joseph, a professor with the University of British Columbia\u2019s Department of Obstetrics and Gynecology and the School of Population and Public Health, who was the lead author of the study. <\/p>\n

The new study suggests that 38% of direct obstetrical deaths and 87% of indirect obstetrical deaths from 2018 to 2021 were identified because of a positive pregnancy checkbox, and these deaths were associated with \u201cincreases in less specific and incidental causes of death.\u201d However, when the researchers identified maternal deaths using a \u201cdefinition-based approach,\u201d with at least one mention of pregnancy among the multiple causes of death, the results were significantly different. <\/p>\n

Using the methodology from the National Vital Statistics System, the maternal death rate increased from about 9.7 deaths per 100,000 live births in 1999 to 2002 to 23.6 deaths per 100,000 live births in 2018 to 2021, according to the new study. But using the researchers\u2019 alternative methods, the maternal death rate changed only from 10.2 deaths to 10.4 deaths per 100,000 live births in the same time periods. They found that deaths from direct obstetrical causes, such as preeclampsia, actually decreased. <\/p>\n

Several previous studies, including a 2020 report published by the CDC, \ufeffhave found that maternal mortality rates appeared to significantly increase after the introduction of these checkboxes. But surveillance methods have continued to be refined, and recent reports from the National Center for Health Statistics don\u2019t compare trends in maternal mortality with data before 2018. <\/p>\n

By presenting maternal death rates as an average for 2018 to 2021, the new study also doesn\u2019t account for potential shorter-term trends \u2013 including impacts of the Covid-19 pandemic. <\/p>\n

The latest report from the National Center for Health Statistics says that 1,205 women in the US died of maternal causes in 2021. The maternal mortality rate had jumped more than 60% over the course of two years, from about 20 deaths per 100,000 live births in 2019 to about 33 deaths per 100,000 live births in 2021. <\/p>\n

Experts agree that the surveillance methods aren\u2019t perfect but stress that high maternal mortality rates remain an important issue to address in the US. <\/p>\n

\u201cWe feel fairly confident that there has been an increase [in maternal mortality], particularly during the pandemic,\u201d said Robert Anderson, chief of mortality statistics for the CDC.\u00a0\u201cWe went from underestimating to overestimating, so we had to make that correction. But I feel fairly confident that the increases since 2018 are real.\u201d <\/p>\n

There could be some variability in the quality of reporting over the years, he said, but it would be \u201cnon-statistical variability.\u201d <\/p>\n

Improving the data on the front end<\/h2>\n

The pregnancy checkbox included on death certificates in the US asks whether the person was pregnant or recently pregnant but does not address whether the pregnancy contributed to the death. Experts say that clarifying the purpose of the checkbox in a more direct way could help improve the quality of data collection. <\/p>\n

When it comes to the use of checkboxes in maternal death counts, \u201cthe pregnancy checkbox shouldn\u2019t be taken as proof of a pregnancy, but the\u00a0case\u00a0needs to be looked at further before it\u2019s added to the total,\u201d said Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University School of Medicine and the\u00a0former\u00a0medical director of the California Maternal Quality Care Collaborative, who was not involved in the new study. <\/p>\n

In March 2022, the CDC sent out additional guidance to death certifiers, which resulted in some states implementing a process in which certifiers confirm additional information for maternal deaths. And there\u2019s an ongoing effort to link maternal deaths with birth records or fetal death records to confirm the case, or to flag records without a match for an extra round of review from death certifiers. <\/p>\n

\u201cWhat we really want to do is improve the data on the front end, rather than try to create a workaround to improve the information on the back end,\u201d Anderson said. <\/p>\n

Texas has undertaken significant efforts to refine the data it collects on maternal mortality, developing a four-part \u201cenhanced method\u201d for identifying maternal deaths that has been in place for years. <\/p>\n

The pregnancy checkbox has helped identify some maternal deaths that may have otherwise been missed, but it has also \u201cproven to be open to error,\u201d said Savannah Larimore, manager of maternal mortality and morbidity epidemiology with the Texas state health department. <\/p>\n

Like the new study suggests, Texas has seen general stability in maternal mortality rates in recent years. <\/p>\n

\u201cFrom 2013 to 2019, we\u2019re looking at fluctuation between 17 deaths per 100,000 live births to 20.7 deaths per 100,000 live births,\u201d Larimore said, citing the latest report. \u201cWe do see an increase in 2020 and 2021, and we did supplemental analyses showing that some of that can be attributed to Covid-19-specific mortality.\u201d <\/p>\n

Overall, Main says, \u201cit\u00a0is easy to identify direct maternal deaths \u2013 like the deaths from hemorrhage and hypertension,\u00a0and the deaths from blood clots, those are clearly related to pregnancy. But there\u2019s considerable variation\u00a0around including causes not directly related to the pregnancy, the so-called\u00a0indirect causes of maternal death, such as cancers, heart disease or overdoses.\u201d <\/p>\n

Over the past decade, a number of studies have shown that direct maternal deaths around delivery has fallen, Main said. For instance, a\u00a0study published last year\u00a0found that the rate of pregnant women dying of delivery-related causes in the hospital appears to have declined significantly, by more than 50%, across the United States from 2008 through 2021. <\/p>\n

\u201cWe and many\u00a0others have done a lot of work on addressing\u00a0hemorrhage and hypertensive disorders around birth, and I think that\u2019s helped to reduce direct maternal deaths,\u201d Main said of his own work within the California Maternal Quality Care Collaborative. <\/p>\n

\u201cWhere we have not spent as much effort\u00a0\u2013 and where there are more challenges \u2013 is in the postpartum period,\u201d he said. \u201cCDC data suggests that the biggest\u00a0rise in maternal deaths is in the year following birth, but the postpartum period is also when the data is messier and interventions are much harder.\u201d <\/p>\n

\u2018Immense health inequities\u2019 remain<\/h2>\n

Even though the new study suggests that the nation\u2019s overall maternal mortality rate is not rising as much as previous data has indicated, the United States still appears to have\u00a0a higher maternal mortality rate than other high-income countries around the world, \u201cjust not as terrible,\u201d Main said. <\/p>\n

Also, the study emphasizes findings consistent with federal data that shows significant disparities in maternal death rates, especially among Black women in the US. <\/p>\n

\u201cMany of the deaths that are detected through the checkboxes are correct,\u201d said Dr. Emre Seli, chief scientific adviser for the maternal and infant health nonprofit March of Dimes, who was not involved in the new study. <\/p>\n

\n
    <\/ul>\n<\/div>\n

    \u201cWe agree that we should invest into researchers doing better surveillance of maternal deaths,\u201d he said. \u201cBut the undisputable conclusions of this publication would be that we\u2019re not doing any better in the maternal death scenario today compared to 20 years ago, and there are immense health inequities in the matter.\u201d <\/p>\n

    Seli said there is still a lot of work to do to reduce the rate of maternal deaths in the United States and to better track the number of maternal deaths that occur. <\/p>\n

    \u201cIt is important to have surveillance so that we can measure in a consistent manner how interventions and policies are taking effect. We know from our own reports \u2013 the March of Dimes report titled \u2018Where You Live Matters\u2019 on maternity care deserts and the crisis of access and equity \u2013 we know that more than 5 million women live in counties with no to limited access to maternity care services,\u201d Seli said. <\/p>\n

    \u201cWe know that overall maternity care in the United States is not where it should be,\u201d he said. \u201cAnd we know Black women are much more likely to die when they\u2019re pregnant compared to White women, and this is also shown in the current paper, even when removing the checkbox utilization. So we really do think there\u2019s a lot to be done in making maternal care accessible to all throughout the country.\u201d <\/p>\n<\/p>\n

    This post appeared first on cnn.com<\/div>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"

    Hundreds of women in the United States die from complications related to pregnancy, childbirth and the time after giving birth\u00a0each year, and the country\u2019s high maternal death rate makes it an outlier among developed nations. Federal data shows that maternal mortality has surged in the US in recent years, especially during the Covid-19 pandemic, and …<\/p>\n","protected":false},"author":1,"featured_media":608,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"loftocean_post_primary_category":0,"loftocean_post_format_gallery":"","loftocean_post_format_gallery_ids":"","loftocean_post_format_gallery_urls":"","loftocean_post_format_video_id":0,"loftocean_post_format_video_url":"","loftocean_post_format_video_type":"","loftocean_post_format_video":"","loftocean_post_format_audio_type":"","loftocean_post_format_audio_url":"","loftocean_post_format_audio_id":0,"loftocean_post_format_audio":"","loftocean-featured-post":"","loftocean-like-count":0,"loftocean-view-count":534,"tinysalt_single_post_intro_label":"","tinysalt_single_post_intro_description":"","tinysalt_hide_post_featured_image":"","tinysalt_post_featured_media_position":"","tinysalt_single_site_header_source":"","tinysalt_single_custom_site_header":"0","tinysalt_single_custom_sticky_site_header":"0","tinysalt_single_custom_sticky_site_header_style":"sticky-scroll-up","tinysalt_single_site_footer_source":"","tinysalt_single_custom_site_footer":"0","footnotes":""},"categories":[35],"tags":[],"class_list":["post-607","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-news"],"_links":{"self":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/607","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/comments?post=607"}],"version-history":[{"count":0,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/607\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media\/608"}],"wp:attachment":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media?parent=607"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/categories?post=607"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/tags?post=607"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}