Severe Maternal Morbidity in California

California

The prevalence of severe maternal morbidity has been steadily increasing. Maternal morbidity is any outcome of pregnancy, labor or delivery that leads to short- or long-term health consequences among women, such as cardiovascular disease, infection, bleeding, high blood pressure or blood clots. Severe maternal morbidity includes serious and potentially life-threatening events and outcomes, such as eclampsia or hysterectomy.

The rate of severe maternal morbidity is higher among:

• All non-white racial and ethnic minority women compared with non-Hispanic white women; non-Hispanic Black women have the highest rate.
• Women ages 40 and older and younger than 20 compared with women ages 20-39. 
• Women with preexisting conditions, multiple births (twins, triplets, etc.) or a prior cesarean section. 
• Women who have never given birth before as well as those who have given birth three or more times.

The White House Blueprint for Addressing the Maternal Health Crisis identifies goals and actions for agencies across the federal government to improve health equity. Their goals include increasing access to and coverage of maternal health services, expanding and diversifying the perinatal workforce, supporting data collection and research, and strengthening economic and social support for people. 

Other strategies to prevent maternal morbidity include: 

• Ongoing communication and collaboration among stakeholders, such as health organizations, agencies, providers and researchers. 
• Creating and using multidisciplinary and national best practices, such as those developed by the Alliance for Innovation in Maternal Health in their maternal patient safety bundles. 
• Early and adequate prenatal care and postpartum care.
• Closing the Medicaid coverage gap to allow more women access to care before they become pregnant.
• The use of telehealth to promote and increase access to quality care for minority women in high-risk obstetric clinics and underserved areas.
• Improving data collection and surveillance to better understand the causes of the maternal health crisis, such as reviewing cases of severe maternal morbidity to determine areas of improvement. 

The Community Preventive Services Task Force recommends exercise programs for pregnant women to help reduce risk of developing gestational hypertension as well as lifestyle interventions to help reduce the risk of developing gestational diabetes, two common complications of pregnancy. The American College of Obstetricians and Gynecologists recommends maternal immunization to reduce morbidity and mortality.

Healthy People 2030 has an objective to reduce severe maternal complications identified during delivery hospitalizations.

Ahn, Roy, Grace P. Gonzalez, Britta Anderson, Catherine J. Vladutiu, Erin R. Fowler, and Leticia Manning. “Initiatives to Reduce Maternal Mortality and Severe Maternal Morbidity in the United States: A Narrative Review.” Annals of Internal Medicine 173, no. 11_Supplement (December 1, 2020): S3–10. https://doi.org/10.7326/M19-3258.

Declercq, Eugene, and Laurie Zephyrin. “Severe Maternal Morbidity in the United States: A Primer,” 2021. https://doi.org/10.26099/R43H-VH76.

Fink, Dorothy A., Deborah Kilday, Zhun Cao, Kelly Larson, Adrienne Smith, Craig Lipkin, Raymond Perigard, et al. “Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021.” JAMA Network Open 6, no. 6 (June 22, 2023): e2317641. https://doi.org/10.1001/jamanetworkopen.2023.17641.

Howell, Elizabeth A. “Reducing Disparities in Severe Maternal Morbidity and Mortality.” Clinical Obstetrics and Gynecology 61, no. 2 (June 2018): 387–99. https://doi.org/10.1097/GRF.0000000000000349.

Kilpatrick, Sarah J. “Next Steps to Reduce Maternal Morbidity and Mortality in the USA.” Women’s Health 11, no. 2 (March 1, 2015): 193–99. https://doi.org/10.2217/WHE.14.80.

Nik Hazlina, Nik Hussain, Mohd Noor Norhayati, Ismail Shaiful Bahari, and Halilul Rahman Mohamed Kamil. “The Prevalence and Risk Factors for Severe Maternal Morbidities: A Systematic Review and Meta-Analysis.” Frontiers in Medicine 9 (March 17, 2022): 861028. https://doi.org/10.3389/fmed.2022.861028.

“White House Blueprint for Addressing the Maternal Health Crisis.” Washington, D.C.: The White House, June 2022. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf.