At Maternova, we wanted our first blog of 2019 to focus on something positive that has come out of maternal health advocacy in 2018.
On Friday December 21 2018, H.R.1318 Preventing Maternal Deaths Act was signed into law by the President of the United States. The bill has been in the works for over two years, and amends and expands the Safe Motherhood Initiative within the Centers for Disease Control and Prevention.
It’s no secret that the maternal mortality rates in the USA have been rising, whereas most of the developed world are seeing declining rates. The maternal mortality rate in the USA is around 26.4 deaths per 100,000, whereas most of Western Europe and Canada sees rates below 10 deaths per 100,000. However, the most concerning figure is the maternal mortality rate for black American women, which is 40 per 100,000 compared to 12.4 per 100,000 for white women.
The maternal health dialogue within the USA last year was and still is centered around the high maternal mortality rates in Black women, and rightly so. Being black affects the health and healthcare of pregnant women. Race influences health via various mechanisms, and affects the patient journey starting at research (clinical trials) and development, through to diagnosis and treatment. It transcends all levels and physical boundaries. Although H.R. 1318 allocates funding and resources towards reducing deaths that occur during childbirth and postnatal period, it will need to be channeled into the right areas.
Funding needs to be allocated towards ensuring women get the care they need at the right time, as well as improving the training of health professionals and eliminating existing bias and pre-conceptions when it comes to treating Black patients. However, funding will be incredibly beneficial in racially diverse areas to ensure proper data collection of the outcomes of mothers. Various articles have mentioned the introduction of a confidential enquiry into all maternal deaths, like the one in the UK, which intensely investigates every single maternal death in the country. The investigations are done not to place blame on a single person but to understand the failures of the health system which has led to the deaths of these women. Understanding epidemiology will open up avenues for research and allow targeted approaches when caring for women.
Funding allocated to research can ensure medical research actually includes Black and Hispanic women. Dr Kacey Eichelberger and colleagues highlighted that the perspectives of current OB/GYNs need to change – there appears to be an acceptance that Black women do worse in studies or are absent from clinical trials, and this is not questioned. This only reinforces the lesser value society has placed on Black lives. Success in trials should look at racially equitable outcomes.
There were many articles produced last year that commented on the genetic predisposition of Black women to disease and poor outcomes in pregnancy, a process called ‘weathering’, whereby environmental and social conditions have affected gene expression, increasing health vulnerability. Although Black women do have a genetic susceptibility to some diseases, it is important for this to not lead to complacency when it comes to addressing structured racism. The interplay of genetic susceptibility and environmental factors is what is killing women. For example, Black women have a higher risk of pre-eclampsia. However, Black women will die from pre-eclampsia if they are not monitored or listened to. The vulnerability of Black women means that the health system should pay even more attention to these women.
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.