La. makes progress in reducing maternal morbidity; doctors discuss the problem of pregnancy-related deaths

Published: May. 5, 2021 at 10:02 PM CDT
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NEW ORLEANS (WVUE) - African American women die much more than white women during and after pregnancy in Louisiana.

And Louisiana is making gains overall in its fight to reduce maternal morbidity.

The state’s point person on the problem as well as an LSU Health New Orleans expert weighed in the problem of deaths of women during or within a year after pregnancy.

Maternal morbidity includes a range of different health conditions that can begin during pregnancy or post-pregnancy.

Dr. Veronica Gillispie-Bell is Medical Director of the Louisiana Perinatal Quality Collaborative as well as the Louisiana Pregnancy-Associated Mortality Review.

“Very proud to say that when we look at severe maternal morbidity from hemorrhage, we saw a decrease by 35 %, specifically 49 % for black birthing persons and then a reduction in severe maternal morbidity related to hypertension by almost 12 %,” said Gillispie-Bell.

Such progress is important because the CDC says about 700 women die each year in the U.S. as a result of pregnancy or delivery complications and Louisiana shares in those deaths.

The Louisiana Pregnancy-Associated Review Report was released in 2020 and is based on 2017 data. That data says there were 65 verified pregnancy-associated deaths that year which represents a pregnancy-associated mortality ratio of 106.7 deaths per 100,000 births. And of the 65 cases, 15 deaths were pregnancy-related, 41 were pregnancy-associated but not related and nine were pregnancy-associated but unable to be determined as related.

“Pregnancy-associated is the big umbrella, that’s all of the deaths, and then pregnancy-related are those deaths that occur because of a condition related to the pregnancy,” said Dr. Gillispie-Bell.

Dr. Robert Maupin is a professor and Chief of the Division of Maternal/Fetal Medicine in the Department of Obstetrics/Gynecology at the LSU Health New Orleans School of Medicine.

“We know that a little bit more than half of the deaths associated with pregnancy occur after the birth and after discharge from the hospital that can be a very vulnerable period when we need to make sure that our healthcare resources and infrastructure remain on point, that we’re able to monitor mothers who are potentially at risk, we’re able to communicate and educate in ways that are culturally respectful,” said Maupin.

In Louisiana data shows African American women die more than white women during or within a year of pregnancy.

According to the Louisiana Pregnancy-Associated Mortality Review Report, among pregnancy-related deaths, 5.6 black women in Louisiana died for every white woman.

“Unfortunately, that is the case, nationally as well, three to four black women, there are states that are higher. New York is eight to 12 black women at a rate of every white woman, so this is not just a Louisiana problem, this is a national problem and there are many efforts that are going forth to try to decrease these disparities,” Gillispie-Bell stated.

She said it is critical that women get health care for existing medical conditions like diabetes and hypertension before becoming pregnant.

“Once the pregnancy has started, we’re already behind the 8-ball and so those effects of hypertension and diabetes are going to be controlled and mitigated as much as possible but really the best care is to optimize the care of those conditions prior to pregnancy so we can make sure we have a healthy baby and a healthy mom,” she said.

Dr. Maupin says there are many factors that influence maternal mortality.

“When we look at maternal deaths, we know that there are a host of different factors that intersect and we know that there are areas in which the way our healthcare systems are structured that we need to look at improvements and we need to look at how we can advance quality in a number of areas,” he said.

He also believes the business community has a role in helping expectant mothers remain healthy.

“Moms who are diabetic while at work need to be able to navigate monitoring their blood sugars, address nutrition and take medication; the same thing with high blood pressure,” said Maupin. “These are areas in which we shouldn’t have a mother making a choice between employment responsibilities versus some essential areas in terms of healthcare support or making appointments.”

According to the Louisiana Department of Health, in reducing severe maternal morbidity in women who experienced hemorrhaging by 35 % the state exceeded its goal of a 20 % reduction.

However, in reducing severe maternal morbidity related to hypertension by nearly 12 percent, the goal of 20 % was not achieved.

Gillispie-Bell says that could be due to a number of factors.

“We do know that hospitals were starting to work on some processes related to hemorrhage in 2016, so I think that’s one reason that we saw such a greater improvement in processes related to hemorrhage compared to hypertension,” said Gillispie-Bell. “I think the other part related to hypertension that we still are not sure how it affected outcomes is the pandemic. We do know that as pregnant patients with COVID were presenting to the hospital, especially in the early stages.”

On Capitol Hill, the Black Maternal Health Momnibus Act awaits action.

“We do support aspects of the federal Momnibus Act and in fact I’ve been asked to testify for Congress tomorrow for the Committee on Oversight and Reform. They’re having a hearing on black maternal health,” said Gillispie-Bell.

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