August 22, 2024
Every 2 minutes a woman dies from preventable causes attributed to pregnancy and childbirth across the globe. That’s 800 women per day, with figures showing that Black women account for 3.5 times the rate of their White counterparts. Though there has been significant progress in reducing maternal mortality rates over the years, the number of women who die from maternal causes in the US has more than doubled in the past 20 years, and is the highest among the developed nations, highlighting the need for better maternal health practices.
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Several social risk factors are associated with inequities in maternal health, including of a Black or ethnic minority background, lower socioeconomic status and geographic isolation. Given the current fragmentation of the US healthcare systems, these marginalized communities face greater struggles when accessing maternal healthcare. There is, therefore, a need for a push to enhance prenatal care across all healthcare sectors, embracing digital innovation and monitoring, so that preventable causes of maternal mortality can be more readily identified and managed across the entirety of the pregnant population.
Hospitalization utilization during pregnancy, separate from that required for delivery, is a daunting experience, not just for the expectant mother, but for her entire family. The anticipation of a smooth, uneventful pregnancy can quickly turn to concern when complications arise.
While figures on hospitalization during pregnancy are scarce, research suggests approximately 9% of women experience at least one hospitalization during their pregnancy, with one 2022 study finding nearly half of pregnancy-related deaths happen during inpatient hospitalizations pre and post birth.
Pregnant adolescents and older women, as well as those from lower socioeconomic backgrounds or with a lower level of education are particularly vulnerable to severe complications, with 1 in 4 hospitalized receiving fewer prenatal consultations. Common reasons for hospitalization during pregnancy include hypertension, pre-eclampsia, urinary tract infections (UTIs), premature labor, and fetal growth restriction. These conditions, if left unmanaged, can lead to serious outcomes such as maternal, fetal, and infant morbidity and mortality.
For instance, the CDC has found that UTIs, which are relatively common in most females, affect 17.3% of pregnant women, with 3.8% of cases requiring hospitalization. Gestational hypertension can escalate to emergency situations and severe conditions like pre-eclampsia and HELLP syndrome, which also contribute to maternal mortality.
More than 80% of maternal deaths in the US are preventable, 22% of which occur during pregnancy, 25% on the day of pregnancy, and 53% up to a year following delivery.
The leading underlying causes of pregnancy-associated deaths include mental health conditions (23%), hemorrhage (14%), cardiac and coronary conditions (13%), thrombotic embolism (9%), cardiomyopathy (9%) and hypertensive disorders of pregnancy (7%). Among Black women, cardiovascular conditions are the leading underlying cause for pregnancy associated deaths, while mental health issues among Hispanic and White women, and hemorrhage among Asian women, are the most common causes.
Federally Qualified Health Centers (FQHCs) play a vital role in providing community-based care to underserved populations. In 2020, FQHCs served over 16.8 million women and 566,000 pregnant persons, making them ideal for implementing and studying postpartum quality improvement (QI) interventions. One effective QI approach is the learning collaborative, where similar organizations share ideas and experiences to enhance healthcare delivery. These initiatives have successfully improved perinatal outcomes, as seen in Illinois, supporting the role which certain digital health apps play in connecting providers and patients together.
In a recent intervention, 19 clinics within six participating FQHCs used patient registries to track high-risk prenatal patients and ensure they received primary care within six months of delivery. This initiative led to a significant increase in the proportion of high-risk patients with documented primary care visits, rising from 25% to 72%.
This evidence reiterates that timely access to obstetric and gynecologic healthcare dramatically improves maternal and neonatal outcomes. However, many women in the United States live in healthcare deserts, where reliable medical services are scarce. This lack of access means that even minor complications can escalate into serious issues.
Telehealth has emerged as a saving grace for these women, particularly those from lower socioeconomic backgrounds. Studies show that telehealth interventions significantly increase the use of prenatal and postnatal care. Recent research on the use of telehealth to address some of the most pressing maternal health outcomes in the prenatal and postpartum periods, including hypertension, gestational diabetes mellitus, and mental health issues, found that home blood pressure monitoring during pregnancy reduced prenatal visits. This monitoring also reduced prenatal hospital admissions, and diagnosis of preeclampsia, with no differences in maternal, fetal or neonatal outcomes between home monitoring and conventional care. Other research highlights improvements in health behaviors, such as maintaining healthy blood glucose levels in gestational diabetes and promoting smoking cessation.
Telehealth also reduces the need for frequent high-risk obstetric visits, making it easier for women to receive consistent care. This is particularly beneficial for those who might otherwise struggle to access regular check-ups due to distance or financial constraints.
Furthermore, regular prenatal care, when supported by digital health platforms, educates women on vital health practices. These apps can encourage the maintenance of a healthy diet and provide access to nutritional support, set reminders for prenatal health checks, and allow for data sharing so that essential metrics are shared with providers. This level of comprehensive care promotes fetal health and development, and reduces bureaucratic obstacles to ensure mothers receive timely, expert care, which significantly improves outcomes for mothers and babies.
Investing in quality prenatal care also brings substantial economic benefits. In 2019, maternal morbidity conditions in the U.S. cost $32.3 billion from conception through a child’s fifth birthday, averaging $8,624 per mother-child pair. Two-thirds of these costs occurred within the first year postpartum, with the healthcare system bearing 58% of these expenses. The remaining costs impacted employers, social services, and nonmedical sectors, including $6.6 billion in productivity losses and $6.5 billion in costs associated with children's behavioral and developmental disorders.
Effective prenatal care can significantly reduce these expenses by preventing complications, decreasing the need for interventions like cesarean sections, promoting breastfeeding and addressing suicidal ideation.
Platforms such as US based Mother Goose Health play a crucial role by providing nutritional advice, access to food programs like SNAP and WIC, expert doula services, and access to mental health care, among a multitude of other services that not only improve health outcomes but also ease the financial burden on society, highlighting the importance of comprehensive prenatal care. This innovative approach has led to the identification of 32% of mothers with preterm birth risk factors within the first trimester and a 55% lower preterm birth rate among its users compared to those not using the platform.
By increasing engagement in prenatal appointments, remotely monitoring mothers throughout their pregnancy using digital technologies and sharing data across providers with EHR integration, maternal management care platforms can detect rising risk, intervening early to prevent the escalation of complications, improving outcomes, saving money, and ultimately saving lives.