You would think that with each passing year, incidents of complications during pregnancy and childbirth would decrease. But the recent Health of America report from the Blue Cross Blue Shield Association shows otherwise.
Overall, pregnancy complications rose by more than 16% in recent years. Childbirth complications saw an increase of more than 14%. As a physician, this is troubling to me.
A review of 1.8 million pregnancies (ages 18-44) nationwide between 2014 and 2018 offered significant findings:
- Over the survey period, more pregnant women had pre-existing conditions. These included hypertension, type II diabetes, obesity, major depression, anxiety, and substance use disorder.
- The number of women experiencing pregnancy and childbirth complications rose by 31.5%.
- Postpartum depression diagnoses climbed by 30%. (Note: Part of this increase may be due to better screening and identification of symptoms.)
The rate of substance use disorder (SUD) among pregnant women was up 24% during the survey period. Here in North Carolina, opioid use by pregnant mothers has risen.
Nationwide, depression during pregnancy spiked by 35%. Preexisting behavioral health conditions pose a greater risk for postpartum depression. More than two-thirds of women diagnosed with postpartum depression had at least one behavioral health diagnosis before pregnancy.
The Health of America research complements evidence that race plays a role in pregnancy outcomes. We know that Black women are more likely to experience complications from pregnancy. Black women face maternal mortality rates three to four times higher than white mothers.
COVID-19 IS ADDING TO THE COMPLICATIONS
All of us are coping with the health and social challenges brought on by COVID-19. The link between our physical and mental health has never been more obvious.
Social isolation can contribute to traumatic birth experiences. This is because we lack contact with our usual support groups. This can also contribute to medical complications and a lack of post-birth support.
We don’t have to contract COVID-19 for our health – and the health of a newborn baby – to be affected by the virus.
COLLABORATING FOR BETTER MATERNAL HEALTH
The latest Health of America report lists states in order of pregnancy rate in recent years. North Carolina is at #7. That’s one reason why Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working to improve maternal health in our state. We’re investing in communities to maximize the chances of healthy pregnancies and births.
Working with Eleanor Health, Blue Cross NC is approaching SUD as a chronic disease. Eleanor Health’s programs include treatment for expectant mothers. Eleanor’s whole-person approach treats both the physical and mental health impacts of SUD.
Primary care doctors also need tools to more effectively connect expectant mothers with SUD treatment resources. This is particularly important in identifying SUD among pregnant women. Physicians need tools and resources to diagnose SUD.
Using the Quartet platform, physicians can more easily refer patients to a trusted network of mental health providers. Working with Quartet, we’ve launched a statewide initiative to integrate mental health into primary care. The initiative expands access to mental health services.
Statistics are points on a road map. As much as telling us where we’ve been, they tell us where we’re headed. The Health of America report tells us we’re going in the wrong direction on maternal health. We must change that.
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