A new study from Northwestern Medicine reveals a concerning increase in serious maternal health problems and birth complications in Illinois from 2016 to 2023, closely linked to increases in chronic health conditions that affect pregnancy, such as high blood pressure, gestational diabetes, mental health disorders and especially obesity, which saw the largest increase in annual rates.
Study highlights important racial and socioeconomic disparities, finding that non-Hispanic black mothers faced more than twice as many serious complications compared to non-Hispanic white mothers, and that living in high-poverty neighborhoods elevated maternal health risks across all racial groups.
“Despite significant recent efforts to improve quality across the state, these birth outcomes are worsening at all ages, reflecting the worsening pre-pregnancy health of the reproductive-age population in Illinois,” he said. corresponding author Dr. Mugdha Mokashi, resident physician in obstetrics and gynecology. at McGaw Medical Center at Northwestern.
The findings reflect national trends demonstrating the increasing prevalence of conditions such as obesity, hypertensive disorders of pregnancy and gestational diabetes among pregnant people of all ages, he added. The study provides the most up-to-date data on maternal morbidity and birth complications in the state of Illinois.
The findings were published Nov. 21 in the journal Open Obstetrics and Gynecology.
“Our findings underscore the role of social determinants of health (such as race and income) in driving disparities in maternal health, suggesting that efforts to reduce maternal morbidity must address both racial inequalities and as economic difficulties,” said the study’s co-author. Dr. Lynn Yee, associate professor of obstetrics and pulmonology at Northwestern University Feinberg School of Medicine and maternal-fetal physician at Northwestern Medicine.
Breakdown of findings:
In the study cohort of 988,480 births at 127 Illinois hospitals between January 2016 and June 2023, the overall rate of severe maternal morbidity increased from 1.4% in 2016 to 2% in 2023. Vaginal birth complications increased by 22.4% and complications from cesarean delivery increased by 48.9%.
Hypertensive disorders of pregnancy and anemia (which increased during the study period) were important risk factors for severe maternal morbidity and delivery complications. The largest increase, by far, was in annual obesity rates from 2016 to the first six months of 2023 (7.8% to 22.3%). Additionally, there were increases in gestational diabetes (4.2% to 5.5%), depression (2.5% to 6.6%), anxiety (3.1% to 10.4%), and other chronic comorbidities ( 4.7% to 7.4%). Non-Hispanic black patients had more than twice the rate of severe maternal morbidity (2.6%) compared to non-Hispanic white patients (1.1%).
Health counseling before pregnancy is important
Maternal health affects almost everyone, and those thinking about getting pregnant should be sure to check with their health care provider to check for any chronic conditions they may have before getting pregnant, the study authors said.
“Preconception counseling is a very important way to ensure that all your health conditions are optimized before pregnancy,” Mokashi said. “There are many important policies and public health initiatives in Illinois that people may be interested in learning more about.”
“It’s not just because people who get pregnant are older”
While not the original goal of the study, scientists conducted additional analyzes that found that the higher prevalence of maternal health problems and birth complications is not simply because people who become pregnant are older. The findings reflected an increase in hospital coding of hypertensive disorders of pregnancy, gestational diabetes, anemia, depression, serious mental illness and other chronic conditions, especially obesity, even among those who give birth before age 30.
“In short, even young pregnant patients have more medical conditions and complications during pregnancy,” Mokashi said.
What can be done?
Poverty alleviation policies, such as Illinois’ proposed refundable child tax credit, House Bill 4917, if passed, have shown improvements in maternal health, the study authors said.
Perinatal quality initiatives in California have reduced morbidity related to postpartum hemorrhage. Similarly, the Illinois Perinatal Quality Collaborative is working to reduce cesarean births and address racial disparities through Vaginal Birth Promotion and Birth Equity initiatives.
Increasing access to doula support and patient counseling programs could also be helpful support, Mokashi said. In 2024, the Illinois Department of Health Care and Family Services adjusted reimbursement for doula services. At Northwestern, research on patient navigation programs has shown promise in reducing disparities in postpartum care for low-income minority patients. And at the federal level, passage of the 13 bills that make up the reintroduced Black Maternal Health Momnibus Act in 2023 would provide critical financial support to increase data collection and quality initiatives for maternal morbidity prevention.