07 Jul Maternal Mortality Within Hospitals Drops Over 50%
MedicalResearch.com Interview with:
Dorothy A. Fink, MD
Deputy Assistant Secretary for Women’s Health
Director, Office on Women’s Health
US Department of Health & Human Services
MedicalResearch.com: What is the background for this study?
Response: Delivery-related mortality in U.S. hospitals has decreased for all racial and ethnic groups, age groups, and modes of delivery while the prevalence of severe maternal mortality (SMM) increased for all patients, with higher rates for racial and ethnic minority patients of any age.
This study specifically looked at inpatient delivery-related outcomes and found a 57% decrease from 2008-2021. The decreasing mortality rates within the inpatient delivery setting demonstrated as statistically significant and a welcome finding for all women.
This study also looked with greater granularity at the impact of race, ethnicity, and age. Mortality for American Indian women decreased 92%, Asian women decreased 73%, Black women decreased 76%, Hispanic women decreased 60%, Pacific Islander women decreased 79%, and White women decreased 40% during the study period.
MedicalResearch.com: What are the main findings?
Response: The severe maternal mortality at the time of delivery increased by 2% annually with an overall increase of 22% from 2008 – 2021. While these findings do not have the same level of statistical confidence as identified with mortality, this data does clearly support the importance of the need to address maternal health across the continuum. This study also drilled further into the data to reflect the impact of severe maternal mortality on race, ethnicity, age, and payer. Between 2008 – 2021 SMM for American Indian women increased 57%, Asian women increased 79%, Black women increased 10%, Hispanic women increased 28%, Pacific Islander increased 126%, and White women increased 20% in the study period.
Severe maternal mortality is likely increasing due to the overall health of U.S. women giving birth, including increases in maternal age, obesity, and preexisting medical conditions. The study also indicates a correlation to the rise of SMM and association with cesarean births. Continued national effort to reduce low risk cesarean deliveries is needed.
The most common delivery-related complications identified were disseminated intravascular coagulation, acute respiratory distress syndrome, acute kidney failure, sepsis, and eclampsia. The most common risk factors for these complications are obesity, gestational diabetes, tobacco use, gestational hypertension, and asthma.
The fact that many of the comorbid conditions are risk factors for mortality and SMM indicates that it is essential to consider these conditions when assessing SMM and mortality and that better management of patients’ conditions during pregnancy may help reduce SMM occurrence and ultimately decrease mortality risk.
MedicalResearch.com: What should readers take away from your report?
Response: Although other studies have documented a decreasing in-patient mortality trend, it may be new information for many. Much of the reporting on maternal mortality has focused on the increasing maternal mortality rates. As a result, this has led many people to believe that hospitals may be the main cause of maternal mortality. This study specifically looked at in-patient delivery-related outcomes and found a 57% decrease from 2008-2021.
This decline in deaths during delivery hospitalization likely demonstrates the impact of national and local strategies to improve the quality of care by hospitals during delivery-related hospitalizations. This includes HHS quality improvement activities such as state Perinatal Quality Collaboratives and the Alliance for Innovation on Maternal Health, and ties into the Administration’s commitment to addressing the maternal health crisis through initiatives in the White House Blueprint for Addressing the Maternal Health Crisis.
MedicalResearch.com: What recommendations do you have for future research because of this study?
Response: HHS is committed to advancing maternal and infant health research. This includes looking into root causes of mortality and the impact of pre-existing conditions on delivery-related complications to identify opportunities and effect optimal maternal health outcomes.
This study looked at in-patient delivery-related outcomes and found a 57% decrease from 2008-2021. The decreasing mortality rates within the in-patient delivery setting demonstrated as statistically significant and a welcome finding for all women. HHS is continuing to drill into these outcomes and will provide insights in future studies.
Additionally, this study identified comorbid conditions such as obesity, gestational diabetes, tobacco use, gestational hypertension, and asthma are risk factors for mortality and SMM which indicates it is essential to consider comorbid conditions when assessing SMM and mortality. Better management of patients’ comorbid conditions during pregnancy may help reduce SMM occurrence and ultimately decrease mortality risk.
Future research must focus on better understanding how comorbid conditions impact SMM and mortality and how we can better address these conditions through public health interventions. Furthermore, we need to better understand the causes of mortality that occur outside of the hospital setting since in-patient mortality is improving.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Obstetrical providers are essential to care, management, and education of women before, during and after pregnancy to identify conditions that may negatively impact maternal and infant outcomes. These providers are essential drivers of hospital quality improvement efforts such as implementation of maternal safety bundles and support of the Alliance for Innovation on Maternal Health (AIM) Program.
Inpatient mortality rates have significantly decreased, which is a positive reflection of overall efforts to address this national issue. All providers, particularly obstetrical providers who are responsible for maternal care, are critical to advancing and sustaining national quality improvement efforts focused on identification and management of conditions impacting maternal health outcomes.
Citation: Fink DA, Kilday D, Cao Z, et al. Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. 2023;6(6):e2317641. doi:10.1001/jamanetworkopen.2023.17641
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