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• Posted April 7, 2023

Birth Complications? Risk May Rise Depending on Where in U.S. You Live

Where a woman lives in the United States has a lot to do with whether she has severe maternal complications from childbirth, according to new research using Medicaid data.

Her race or ethnicity also greatly affects this, researchers found.

"Near misses" -- where complications could have led to the death of the woman during pregnancy or delivery -- are highest in Washington, D.C., numbering 210 per 10,000. They are lowest in Utah, at 80 per 10,000.

"Our findings suggest wide variation in rates and potential causes of severe maternal morbidity by state, and by race and ethnicity across and within states,"said lead author Dr. Lindsay Admon, an assistant professor of obstetrics and gynecology at the University of Michigan Medical School.

"This data highlights states that have the greatest burden of severe maternal complications and may help guide and tailor interventions aimed at reducing morbidity among those at highest risk,"Admon said in a university news release.

After Washington, D.C., California, Nevada, New Jersey and New York had the highest rates of severe maternal health complications. States with the lowest rates after Utah were Maryland, Rhode Island, Nebraska and New Hampshire.

The researchers analyzed national data from 4.8 million live births among Medicaid enrollees between 2016 and 2018. This data included unanticipated outcomes that caused significant short- or long-term health consequences within six weeks of delivery.

Overall, 146 out of every 10,000 live births involved serious complications, including eclampsia, sepsis and acute heart failure.

Medicaid pays for more than 2 in every 5 births in the United States. This includes a disproportionate number of births to those at highest risk of death and complications, including Black Americans and Indigenous people, rural residents and those who live in lower-income ZIP codes, according to the study.

"Medicaid enrollees are at the highest risk of maternal morbidity and mortality,"Admon said. "Many states are pursuing clinical interventions and health policies designed to address maternal health inequities through Medicaid programs. But until now, we haven't had a big picture view of health outcomes on a geographic and demographic level to inform these decisions."

State-by-state outcomes differed depending on a woman's racial or ethnic group, the study noted.

Among Black women, the three states with the highest rates of severe maternal complications were Alaska, New York and New Jersey. Those with the lowest rates among this group were New Mexico, North Dakota and Utah.

For white women, California, West Virginia and South Carolina ranked highest for severe outcomes while Utah, North Dakota and Maine ranked lowest.

Eclampsia, a rare but life-threatening condition, was the leading cause of severe maternal complications. It's due to high blood pressure and can cause seizures.

Conditions varied by state and race. Eclampsia was the leading maternal complication in Texas, for example, but Black Texans experienced acute heart failure as the leading driver. For white Texans, it was sepsis.

"Previous research suggests that preexisting chronic conditions like obesity, diabetes and mental health conditions are linked to greater risk for adverse maternal health outcomes,"Admon said. "We need to focus on interventions that improve the overall health of our reproductive-aged population and identify clinical, societal and structural barriers that may prevent individuals from achieving optimal health before pregnancy."

The study follows in the wake of a report from the U.S. Centers for Disease Control and Prevention revealing a significant jump in maternal deaths during the pandemic.

The new study findings were published in Obstetrics & Gynecology.

More information

The U.S. National Library of Medicine has more on eclampsia.

SOURCE: University of Michigan, news release, April 6, 2023