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Illinois sees troubling spike in severe pregnancy-related complications

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A new study reveals a troubling rise in severe maternal health issues and birth complications in Illinois from 2016 to 2023, closely linked to increases in chronic health conditions affecting pregnancy, such as high blood pressure, gestational diabetes, mental health disorders and especially obesity, which saw the largest increase in annual rates.

The study highlights significant racial and socioeconomic disparities, finding that non-Hispanic Black mothers faced more than double the rate of severe complications compared to non-Hispanic white mothers, and that living in high-poverty neighbourhoods elevated maternal health risks across all racial groups.

“Despite significant recent state wide quality-improvement efforts, these birth outcomes are worsening for all ages, reflecting the worsening pre-pregnancy health of the reproductive-age population in Illinois,” said corresponding author Dr. Mugdha Mokashi at the 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, she added.

The study provides the most updated data on maternal morbidity and delivery complications within the state of Illinois.

“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 need to address both racial inequalities and economic hardship,” said study co-author Dr. Lynn Yee at Northwestern University Feinberg School of Medicine.

Breaking down of the findings:

In the study cohort of 988,480 births at 127 Illinois hospitals between January 2016 to June 2023, the overall rate of severe maternal morbidity rose from 1.4 per cent in 2016 to 2 per cent in 2023. Vaginal birth complications increased 22.4 per cent, and caesarean birth complications increased 48.9 per cent.

Hypertensive disorders of pregnancy and anaemia — both of which increased over the study period — were significant risk factors for severe maternal morbidity and birth complications.

The largest increase by far was in annual rates of obesity from 2016 to the first six months of 2023 (7.8 per cent to 22.3 per cent).

Additionally, there were increases in gestational diabetes, depression, anxiety and other chronic comorbidities. Non-Hispanic Black patients had more than double the severe maternal morbidity rate compared to non-Hispanic white patients.

Health counselling before pregnancy is important

Maternal health affects almost everyone, and those thinking about pregnancy should be sure to check in with their health care provider to screen for any chronic conditions they may have before getting pregnant, the study authors said.

“Pre-conception counselling is such an important way to make sure that all of your health conditions are optimized prior to pregnancy,” Mokashi said.

“There are many important policy and public health initiatives in Illinois that people may be interested in learning more about.”

‘It’s not just because the people getting pregnant are older’

While not the original aim of the study, the scientists did additional analysis that found the increased prevalence of maternal health issues and birth complications is not simply because the people getting pregnant are older.

The findings reflected an increase in hospital coding for hypertensive disorders of pregnancy, gestational diabetes, anaemia, depression, serious mental illness and other chronic conditions, especially obesity, even among those giving birth who are younger than 30.

“In brief, even young pregnant patients have more medical conditions and complications in pregnancy,” Mokashi said.

What can be done?

Policies for poverty alleviation — such as the proposed refundable child tax credit in Illinois, House Bill 4917, if passed — have demonstrated improvement in maternal health, the study authors said.

Perinatal quality initiatives in California have reduced postpartum hemorrhage-related morbidity. Similarly, the Illinois Perinatal Quality Collaborative is working to reduce cesarean births and address racial disparities through Promoting Vaginal Birth and Birth Equity initiatives.

Increasing access to doula support and patient navigator programmes could also be useful supports, Mokashi said. In 2024, the Illinois Department of Healthcare and Family Services adjusted reimbursement for doula services.

At Northwestern, research on patient-navigator programmes have shown promise in reducing care disparities for low-income minoritised patients postpartum. And at the federal level, passage of the 13 bills comprising the Black Maternal Health Momnibus Act re-introduced in 2023 would provide critical funding support to increase data collection and quality initiatives for prevention of maternal morbidity.

Pregnancy

Early miscarriage care could prevent 10,000 pregnancy losses a year, study finds

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Early miscarriage care after a first loss could prevent about 10,000 pregnancy losses a year in the UK, according to a new study.

The study by Tommy’s National Centre for Miscarriage Research and Birmingham women’s hospital involving 406 women found a 4 per cent reduction in the risk of future miscarriage for women on the graded model of care compared with usual care.

Women in England, Wales and Northern Ireland currently become eligible for specialised NHS care for early baby loss only after they have had at least three miscarriages.

Tommy’s has called for women to become eligible after one miscarriage, saying this could reduce the risk of future miscarriages and improve health outcomes for mothers.

Researchers said that would translate to 10,075 fewer miscarriages a year across the UK.

Kath Abrahams, chief executive of Tommy’s, said women were being “left without early access to services that could help prevent future losses and reduce the debilitating feelings of isolation and hopelessness that we know affect so many who experience pregnancy loss”.

She said: “Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care.

“Put simply, it is the right thing to do. We will do all we can to drive that change across the UK so that more women and families are supported after every miscarriage.”

The graded model of miscarriage care proposed by Tommy’s is already available in Scotland, and the charity is calling for it to be introduced across the whole of the UK.

The graded model includes nurse-led support after one miscarriage, with advice on reducing risk factors such as low vitamin D, folic acid intake, alcohol consumption and caffeine use.

Women who received the specialised care were 47 per cent more likely to have a risk factor identified and receive relevant advice to help prevent future miscarriages than women receiving usual care, the study found.

Among women who had experienced two miscarriages and received the specialised care, one in five were found to have thyroid dysfunction or anaemia, both conditions that can affect pregnancy outcomes.

About one in four pregnancies ends in miscarriage, most often within the first 12 weeks of pregnancy.

The report comes ahead of the long-awaited final findings of the government’s investigation into maternity care in England. Interim findings uncovered a range of failures, including claims that NHS hospitals that caused harm to women and babies during childbirth often resorted to a “cover-up” of their mistakes, falsified medical records and denied bereaved parents answers.

Women’s health minister Gillian Merron said: “Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need.

“I welcome the findings of this important report, and this will be carefully considered as part of our ongoing work to make sure women get the high-quality, compassionate NHS care they deserve.”

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Home blood pressure checks could lower heart risks for new mothers – study

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Home blood pressure checks after hypertensive pregnancy could cut the risk of heart attack, stroke and potentially early death, research suggests.

Women who regularly monitored their blood pressure in the weeks after giving birth, and had doctors tailor their medication if needed, had better functioning arteries nine months later than those who received routine care.

When the medication was adjusted to account for blood pressure changes, the women ended up with less stiff arteries, an effect researchers estimated could reduce the future risk of heart attack or stroke by 10 per cent.

Paul Leeson, professor of cardiovascular medicine who led the study, said the findings suggested that the weeks after birth provided a “powerful and often overlooked opportunity” to protect women’s future health.

“By simply monitoring blood pressure at home, new mothers with hypertensive pregnancies can protect their bodies from future damage,” he said.

High blood pressure, in the form of gestational hypertension or pre-eclampsia, where there are signs of organ damage, affects 5 to 10 per cent of pregnant women.

The condition can damage the mother’s organs and endanger the baby’s life.

Beyond the immediate threat to mother and baby, hypertension in pregnancy can raise the risk of long-term problems, with women three times more likely to develop high blood pressure and twice as likely to have heart disease later in life.

The Oxford team recruited 220 women who developed hypertension in pregnancy. All were on blood pressure medication but were due to reduce their dosage and eventually stop taking the drugs.

In the study, 108 women had standard care in which their medication was reduced based on a few blood pressure checks in the eight weeks after giving birth.

The remaining 112 women used a monitor to check their blood pressure at home each day.

They entered the readings into an app shared with doctors who, if needed, changed their medication day to day, with the aim of giving them better control of their blood pressure.

The new approach led to much better control of the women’s blood pressure, and in tests six to nine months later the women had less stiff arteries.

Stiff arteries are less effective at expanding and contracting, which can drive high blood pressure and ultimately the formation of clots that can block blood vessels and cause heart attacks and strokes.

Trials are now under way to find effective ways of rolling out blood pressure monitoring to women after hypertensive pregnancies. One option is for specialist NHS clinics to deliver the care.

Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, which funded the work, said the results highlighted a crucial window after birth when paying close attention to blood pressure could help protect women’s heart health for years to come.

“We now look forward to seeing results from larger studies with longer follow-up to see how this might save women’s lives,” she said.

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More than half of women with gestational diabetes face harmful stigma, research reveals

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More than half of women with gestational diabetes report stigma from healthcare staff, family, friends and wider society, new research shows.

A survey of 1,800 UK women found widespread emotional distress at diagnosis of the condition, a form of high blood sugar that develops during pregnancy, with effects lasting beyond birth.

Gestational diabetes affects around one in 20 pregnancies in the UK, and the findings highlight the wider toll on women diagnosed with the condition.

The study was funded by Diabetes UK and led by researchers at King’s College London and University College Cork.

Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, said: “Stigma can have a dangerous and devastating impact on pregnant women diagnosed with gestational diabetes, particularly at a time when emotions and anxieties may already be heightened.

“We know that stigma can lead to shame, isolation and poorer mental health, and may discourage people from attending healthcare appointments, potentially increasing the risk of serious complications.

“This research highlights the urgent need for better support systems, based on understanding and empathy to ensure no one feels blamed or judged during their pregnancy.”

More than two-thirds of women, 68 per cent, reported anxiety at diagnosis, while 58 per cent felt upset and 48 per cent experienced fear.

The psychological impact continued beyond birth, with 61 per cent saying the condition negatively affected their feelings about future pregnancies.

Nearly half of women, 49 per cent, felt judged for having gestational diabetes, while 47 per cent felt judged because of their body size.

More than 80 per cent felt other people did not understand gestational diabetes, and more than a third, 36 per cent, concealed their diagnosis from others.

Gestational diabetes stigma was also common in healthcare settings, with 48 per cent reporting that professionals made assumptions about their diet and exercise, and more than half, 52 per cent, feeling judged based on their blood glucose results.

Many women described a loss of control and a sense of disruption during pregnancy.

Nearly two-thirds, 64 per cent, felt they were denied a normal pregnancy, while 76 per cent reported a lack of control over their pregnancy.

More than a third, 36 per cent, felt abandoned by healthcare services after giving birth, and one in four, 25 per cent, continued to experience depression or anxiety postpartum.

Focus group participants described harmful stereotypes, including assumptions that they were ‘lazy’, had ‘poor eating habits’ or ‘lacked willpower’.

Comments from family and friends included remarks such as “should you be eating that?” and “you must have eaten too much, that’s why you have gestational diabetes.”

The researchers are calling for targeted interventions alongside structured emotional support for women during and after pregnancies affected by gestational diabetes, to improve both mental and physical health outcomes.

Professor Angus Forbes, lead researcher from King’s College London, said: “Stigma and emotional distress are far more common in women diagnosed with gestational diabetes than many realise.

“Everyday interactions, even with those who mean well, can deepen this harm, shaping women’s emotional wellbeing and the choices they feel able to make.

“It’s clear that meaningful action is needed to protect women’s mental and physical health.”

Risk factors for gestational diabetes include living with overweight or obesity, having a family history of type 2 diabetes, and being from a South Asian, Black or African Caribbean or Middle Eastern background.

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