Disparities in maternal health linked to severe maternal morbidity

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A recent study revealed that Black women, especially those facing extended travel distances for maternity care, are at a heightened risk of severe maternal morbidity, shedding light on needs for equitable maternal care policies in the United States.

Disparities in maternal health linked to severe maternal morbidity | Image Credit: © WavebreakMediaMicro - © WavebreakMediaMicro - stock.adobe.com.

Disparities in maternal health linked to severe maternal morbidity | Image Credit: © WavebreakMediaMicro - © WavebreakMediaMicro - stock.adobe.com.

Black women and those who must travel farther for maternity care are at an increased risk of severe maternal morbidity (SMM), according to a recent study published in JAMA Network Open.

Takeaways

  1. The United States has the highest rate of maternal mortality among developed nations, emphasizing the urgent need for research on maternal morbidities and associated risk factors.
  2. Maternal health issues, particularly maternal mortality, are notably prevalent in southern U.S. regions such as Mississippi, where the rate is higher than the nationwide average.
  3. An increase in severe maternal morbidity was observed in the United States from 1993 to 2014, indicating the importance of addressing this issue to improve maternal health outcomes.
  4. Data suggests that severe maternal morbidity is more common among Medicaid-insured women compared to those with commercial insurance.
  5. Black women and those who have to travel longer distances for maternity care face a higher risk of severe maternal morbidity.

Among developed nations, the United States has the highest rate of maternal mortality, indicating an urgent need to research maternal morbidities and associated risk factors.Maternal health issues are especially prevalent in southern US regions such as Mississippi. The rate of maternal mortality in Mississippi is 22.1 per 100,000 live births, vs the nationwide rate of 17.4 per 100,000 live births.

The Centers for Disease Control and Prevention defines SMM as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” SMM is a vital indicator for maternal health outcomes and has risen in the United States from 49.5 to 144 per 10,000 live births from 1993 to 2014.

Data has indicated SMM is more common among Medicaid-insured women than women with commercial insurance, indicating a need to investigate health factors in this population. To determine health care access and characteristics among women with a live birth and SMM enrolled in Mississippi Medicaid, investigators conducted a nested case-control study.

Participants included women enrolled in Mississippi Medicaid with a live birth from January 1, 2018, to December 31, 2020. Live birth was identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, and data was obtained from a Mississippi Medicaid coordinated care organization.

ICD-10-CM codes were also used to determine preterm or full-term delivery status, while a previously established algorithm was used to determine pregnancy start date. Exclusion criteria included lack of continuous enrollment during pregnancy and the following 12 months, being aged under 12 years or over 55 years, and being transferred to another institution.

Cases included participants with an SMM event in the 12 months after entry. The date of the first SMM case was defined as the index date. Participants without a reported SMM between delivery and being matched with cases were defined as controls.

Sociodemographic characteristics included race and age. Health care access was also reported using the social vulnerability index (SVI). Clinical characteristics were measured using the maternal comorbidity index (MCI).

There were 13,485 patients with live birth included in the analysis, 63.8% of whom were Black and 87% aged 18 to 34 years. SVI indicated 55% of participants were moderately vulnerable and 65.6% had access to maternity care, with a median distance traveled for delivery of 34.2 miles.

An SMM event was reported in 3% of participants, aged a mean 26.8 years. The most common SMM event was pulmonary edema and acute heart failure in 22.4%, followed by sepsis in 21.9%. Cases were more often Black, aged 18 to 34 years, had moderate social vulnerability, and had access to maternity care, at 70.5%, 81.2%, 54.9%, and 66.6%, respectively.

An SMM event was reported in 50.2% of cases within 6 weeks after delivery, 7.1% within 6 to 12 weeks after delivery, and 42.7% more than 12 weeks after delivery. Pregnancy-related visits in the first trimester of pregnancy were reported in 62.4% of cases and postpartum care visits in 29.8%. 

Cases had to travel a mean 183.2 miles from their residence to the delivery center. The mean MCI among cases was 1.12.

Of controls, 63.2% were Black, 86% were aged 18 to 34 years, 53.4% had moderate social vulnerability, and 63.2% had access to maternity care. First-trimester pregnancy-related visits were reported in 54% of controls and postpartum care visits in 28.8%. Controls had to travel a mean 96.7 miles from their residence to the delivery center and had a mean MCI of 0.54.

These results indicated SMM was more common in individuals who were Black, had to travel farther for delivery, and had a higher MCI. Investigators concluded maternal care policies should be developed to increase access to equitable maternity care.

Reference

Maharjan S, Goswami S, Rong Y, et al. Risk factors for severe maternal morbidity among women enrolled in Mississippi Medicaid. JAMA Netw Open. 2024;7(1):e2350750. doi:10.1001/jamanetworkopen.2023.50750

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