A column written by a pair of Wayne State University researchers calling attention to the poor preterm birth and maternal mortality rates in the United States is gaining attention across the nation.
“U.S. preterm birth and maternal mortality rates are alarmingly high, outpacing those in all other high-income countries,” published on Yahoo, Salon, other websites and in newspapers this week, was written by Sonia Hassan, M.D., associate vice president of Women’s Health and founder of Wayne State University’s Office of Women’s Health, and Hala Ouweini, M.D., WSU research associate in Women's Health.
Every two minutes, according to a February 2023 report from the World Health Organization, a woman dies during pregnancy or childbirth. The report reflects a “shameful reality in which maternal deaths have either increased or plateaued worldwide between 2016 and 2020,” Dr. Hassan and Ouweini write. In addition, of every 10 babies born, one is preterm, and every 40 seconds, one of those babies dies.
While the worldwide numbers reflect a serious problem, Hassan and Ouweini write, “… the U.S. in particular has an abysmal record on both preterm births and maternal mortality: Despite significant medical advancements in recent years, the U.S. suffers from the highest maternal mortality rate among high-income countries globally. And the 2022 March of Dimes Report Card, an evaluation of maternal and infant health, gave the United States an extremely poor D+ grade. That data also revealed that the national preterm birth rate spiked to 10.5% in 2021, representing a record 15-year high.”
And, the maternal and infant health crises in the U.S. are worsening. Rates have been increasing since 2018. The U.S. maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births – nearly three times as high as that of France, the country with the next-highest rate of 8.7 deaths per 100,000 live births. The number of women who died within a year after pregnancy more than doubled from 1999 to 2019, with the highest number of pregnancy-related deaths among Black women, increasing from 26.7 per 100,000 births to 55.4 per 100,000 births during that same period.
The U.S. in 2020 also experienced the highest infant mortality rate of all high-income countries, 5.4 deaths per 1,000 live births, in contrast to the 1.6 deaths per 1,000 live births in Norway, the country with the lowest infant mortality rate.
The key to driving these numbers down and saving lives is maternal care during pregnancy, including a simple cervical length screening during pregnancy. Research conducted at WSU and now accepted worldwide indicates patients with a short cervix face a greater risk of the cervix opening too early, resulting in preterm birth and its adverse outcomes. Pregnant women identified as having a short cervix can self-administer vaginal progesterone, which has shown to reduce preterm birth by as much as 40%.
Dr. Hassan leads a first-of-its-kind statewide network of 14 maternal-fetal medicine universities and health care systems working to decrease the rates of pre-term birth and improve the health of pregnant mothers and their infants in Michigan.
The SOS Maternity Network is developing a new model for the delivery of care for pregnant women and newborns, and will participate in rigorous research evaluation led by WSU’s Office of Women’s Health to show the effect of the model.
Despite medical advances nationally, in Michigan the outcomes for pregnant women and newborns continue to worsen. In fact, network leaders said, Michigan is one of the worst states in America for pregnant moms and babies. The March of Dimes’ most recent rankings concluded that the state rated a D+ for efforts to protect the lives and health of pregnant women and infants. The state’s 10.6% preterm birth rate in 2022 was the highest in 15 years. The 6.5 (per 1,000 births) infant mortality rate was well above the national average, and nearly 100 mothers died from complications related to childbirth, a 30% increase from just five years ago.
In addition to focused research and standardizations of best practices statewide, the SOS Maternity Network will increase access to prenatal care through transportation and individualized patient navigators; create a system of incentives for pregnant mothers to have the healthiest pregnancy possible; focus on prevention of preeclampsia and preterm birth, the primary causes of deaths of pregnant women and newborns; and direct incentive payments to health care providers for delivering the most proven, effective care plans for reducing preterm birth and preeclampsia, under best practices as set forth by the network’s medical protocols.