US Preterm Birth And Maternal Mortality Rates Are Alarmingly High: Report

Every two minutes, in about the time it takes to read a page of your favourite book or brew a cup of coffee, a woman dies during pregnancy or childbirth, according to aFebruary 2023 reportfrom the World Health Organisation. The report reflects a shameful reality in which maternal deaths have either increased or plateaued worldwide between 2016 and 2020.

On top of that, of every 10 babies born, one is preterm – and every 40 seconds,one of those babies dies. Globally, preterm birth is theleading causeof death in children under the age of 5, with complications from preterm birth resulting in the death of 1 million children under age 5 each year.

The WHO has designated preterm birth an “urgent public health issue” in recognition of the threat it poses to global health.

US Maternal Mortality Rates

Those numbers reflect a worldwide problem, but 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 thehighest maternal mortality rateamong high-income countries globally. And the 2022 March of Dimes Report Card, an evaluation of maternal and infant health, gave the United Statesan 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.

We are maternal-fetal medicine expertsandscholars of women’s healthwho focus on treatments and programs to help women have better maternal health, especially those that reduce preterm birth.

OurOffice of Women’s Healthleads theSOS Maternity Network, which stands for the Synergy of Scholars in Maternal and Infant Health Equity, a research alliance of maternal-fetal medicine physicians across the state of Michigan.

Maternal and infant death are theworst possible outcomes of pregnancy. These numbers make clear just how crucial it is to change this trajectory and to ensure all Americans have practical access to quality reproductive health care.

The dire state of maternal healthcare

Tori Bowie, an elite Olympic athlete,tragically lost her lifeat just age 32 because of complications of pregnancy and childbirth.

Bowie’s story drives home the devastating state of maternal health in the U.S. Maternal mortality is a sad and unexpected ending to the often beautiful journey of pregnancy and childbirth. It means that a baby has to go without its mother’s love, care and comforting touch and at the same time the family has to mourn the sudden loss of their loved one. Unless substantial progress is made for lowering maternal deaths, the lives of over1 million more womenlike Bowie could be at risk by the year 2030, if current trends continue.

Unfortunately, thematernal and infant health crises are worseningin the U.S., and this association is far from being an unfortunate coincidence. There is an important link between infant health and maternal health, as they both rely on theaccessibility and quality of health care. These U.S. rates have been increasing since 2018 when improved reporting of maternal deaths was adopted.

In 2020, the U.S. maternal mortality rate was 23.8 deaths per 100,000 live births – nearly three times as high as the country with the next-highest rate of 8.7 deaths per 100,000 live births, France.

The number of women who died within a year after pregnancymore than doubled in the U.S.over the 20-year period of 1999 to 2019. And there are significant racial disparities in this statistic: The highest number of pregnancy-related deaths were recorded among Black women, increasing from 26.7 per 100,000 births to 55.4 per 100,000 during that same time period.

Worse yet, the Centers for Disease Control and Prevention has determined that about84% of such maternal deathsare preventable.

Tragic rates of infant mortality and preterm birth

Notably, in 2020 the U.S. also experienced thehighest infant mortality rateof all high-income countries. The U.S. infant mortality rate was 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.

You may have heard the term “preemie” before, perhaps when a loved one delivered a baby more than three weeks before the expected due date. A premature birth is one that occurs before the 37th week of pregnancy. Preterm-related causes are responsible for35.8% of infant deaths in the U.S.

Preterm babies are often not fully physiologically prepared for delivery, which can result in a range of medical complications. While preterm births lead to rising infant mortality rates, even those who survive can face health problems such as breathing difficulties, problems with feeding, significant developmental delay and morethroughout their lives. Preterm birth also presents additional risks for the mother, as women who deliver preterm are at higher risk for cardiovascular complications later in life.

Thus, preterm birthtakes a significant tollon families and their communities, with serious ramifications in medical, social, psychological and financial contexts.

Maternal care during pregnancy is key

Maternal care appointments and screenings are essential to prevent prenatal complications and a women’s increased risk for developinglong-term complications such as cardiovascular disease. For that reason, patients should secure prenatal care as early as possible in the pregnancy and continue to regularly have prenatal care appointments.

Preterm birth can occur unexpectedly in an otherwise normal-seeming pregnancy. It looks no different from the early signs of typical labour, except that it occurs before 37 weeks of pregnancy. The symptoms of premature labour can include contractions, unusual vaginal discharge, the feeling of pressure in the pelvic area, and low dull backache or cramps in the uterus or abdomen. A person who experiences these symptoms during pregnancy should seek medical attention.

Some people are more predisposed to preterm birth based on individual risk factors like substance use, multiple pregnancies – such as twins – infections, race, a medical history of prior preterm delivery and heightened stress levels. Our research team and others have shown thatCOVID-19 is a known risk factorfor preterm birth.

It’s important to speak with your primary care provider to assess how your current health may affect future pregnancy and whether lifestyle changes – such as adopting a healthy diet and active lifestyle and avoiding smoking and drinking alcohol – can improve your likelihood of full-term delivery.

Preterm birth prevention

The more that pregnant women take ownership of their health and ask their doctors to perform a simple cervical length screening during their pregnancy, the earlier preterm birth can be detected and prevented and the more lives will be saved.

Evidence has shown that patients with a short cervix face a greater risk of thecervix’s opening too earlyin pregnancy, resulting in preterm birth and other adverse outcomes. The cervix is the lower section of the uterus, which connects to the vaginal canal. As pregnancy progresses, it stretches, softens and ultimately opens in the process of normal childbirth.

All patients – even those who are seemingly low risk – should ask their doctors to have their cervical length checked by transvaginal ultrasound during pregnancy between 19 and 24 weeks. A short cervical length indicates a high risk of premature delivery. Luckily, there are treatments available, such as vaginal progesterone, which can prevent preterm birth in women found by ultrasound to have a short cervix. This treatment canreduce the risk of preterm birth by more than 40%.

We are optimistic that with greater awareness of these issues and a shift in the focus to evidence-based practices coupled with increased access to vulnerable populations, the U.S. can begin to give women like Bowie and so many others the health care they and their infants deserve.

Sonia Hassan is a Professor of Obstetrics and Gynecology and Maternal Fetal Medicine, Wayne State University, Hala Ouweini is a Research Associate in Women's Health, Wayne State University, published the article first in The Conversation. 

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