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Florio KL, Johnson TN, Williams EM, Ramaeker D, Gosch K, Otto A, Ahluwalia A, Schmidt L, Williams A, Lewis E, Chrans M, Rideout R, Spertus JA, Kendig S. Cardiovascular disease and maternal mortality: perceptions in a Midwest birthing population. Am J Obstet Gynecol MFM 2024; 6:101296. [PMID: 38336173 DOI: 10.1016/j.ajogmf.2024.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Missouri has one of the highest rates of maternal mortality in the United States. To date, there are currently no studies describing birthing peoples' knowledge or perceptions of contributing causes of maternal mortality. An improved understanding of population-specific knowledge can help to define how best to design targeted interventions to reduce disease-specific causes of maternal mortality. OBJECTIVE This study aimed to examine the knowledge and understanding of maternal mortality in a Missouri birthing population. STUDY DESIGN A 46-question, cross-sectional survey to assess the familiarity with local maternal mortality rates, groups affected, and causality was developed by the Missouri Perinatal Quality Collaborative and the Maternal-Child Learning and Action Network and emailed to a random sample of birthing people across Missouri. Those who identified as someone with birthing potential with a Missouri zip code and who were ≥18 years of age were eligible for inclusion. Unadjusted descriptive statistics were generated and stratified by age, race, and region. RESULTS Among 2196 surveys sent, 1738 people completed the survey. Of those who responded, 78.2% were aware of the risk of pregnancy-related death with 14.7% reporting that they intimately knew someone who died. When asked if a certain group is affected disproportionately more, 66.4% responded affirmatively. Black (58.7%), uninsured (61.8%), poor (71.0%), those with substance abuse disorders (57.4%), and Native American (28.8%) birthing people were identified as groups that were perceived as suffering higher rates of maternal death. When polled on etiology, severe bleeding (56.9%) was believed to be the leading cause of death, and the second stage of labor was thought to be the period of highest risk (42.3%). Beliefs about the timing of death differed by age (P=.042) but not race (P=.81) or region (P=.191). CONCLUSION Missouri birthing people are cognizant of the social factors associated with increased maternal mortality but are unaware of the leading causes of death, namely cardiovascular disease and mental health conditions. Future Perinatal Quality Collaborative work should focus on campaigns that raise public awareness about cardiovascular disease and mental health-related birthing risks and the importance of monitoring early warning signs after delivery.
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Affiliation(s)
- Karen L Florio
- Department of Obstetrics and Gynecology, University of Missouri, Columbia MO (Dr Florio); Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, Kansas City, MO (Drs Florio, Johnson, and Ahluwalia, and Drs Schmidt and Spertus); Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Florio and Ramaeker); School of Medicine, University of Missouri-Kansas City, MO (Dr Florio).
| | - Traci N Johnson
- Department of Obstetrics and Gynecology, University of Missouri - Kansas City, Kansas City, MO (Drs Johnson, Williams, and Ramaeker)
| | - Emily M Williams
- Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, Kansas City, MO (Drs Florio, Johnson, and Ahluwalia, and Drs Schmidt and Spertus); Department of Obstetrics and Gynecology, University of Missouri - Kansas City, Kansas City, MO (Drs Johnson, Williams, and Ramaeker)
| | - Devon Ramaeker
- Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Florio and Ramaeker); Department of Obstetrics and Gynecology, University of Missouri - Kansas City, Kansas City, MO (Drs Johnson, Williams, and Ramaeker)
| | - Kensey Gosch
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Ms Gosch and Dr Schmidt)
| | - Ashlie Otto
- Missouri Department of Health and Senior Services, Jefferson City, MO (Ms Otto)
| | - Amit Ahluwalia
- Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, Kansas City, MO (Drs Florio, Johnson, and Ahluwalia, and Drs Schmidt and Spertus)
| | - Laura Schmidt
- Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, Kansas City, MO (Drs Florio, Johnson, and Ahluwalia, and Drs Schmidt and Spertus); Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Ms Gosch and Dr Schmidt); Mid-America Heart Institute of Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Spertus and Dr Schmidt)
| | - Alison Williams
- Missouri Hospital Association, Jefferson City, MO (Ms Williams and Lewis)
| | - Elizabeth Lewis
- Missouri Hospital Association, Jefferson City, MO (Ms Williams and Lewis)
| | - Mariah Chrans
- Community Health Council of Wyandotte County, Kansas City, KS (Dr Chrans)
| | | | - John A Spertus
- Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, Kansas City, MO (Drs Florio, Johnson, and Ahluwalia, and Drs Schmidt and Spertus); Mid-America Heart Institute of Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Spertus and Dr Schmidt)
| | - Sue Kendig
- SSM Health-Saint Louis, Saint Louis, MO (Ms Kendig)
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Phung B. Policy measures to expand home visiting programs in the postpartum period. Front Glob Womens Health 2023; 3:1029226. [PMID: 36683604 PMCID: PMC9846606 DOI: 10.3389/fgwh.2022.1029226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
The postpartum period is characterized by a myriad of changes-emotional, physical, and spiritual; whilst the psychosocial health of new parents is also at risk. More alarmingly, the majority of pregnancy-related deaths in the U.S. occur during this critical period. The higher maternal mortality rate is further stratified by dramatic racial and ethnic variations: Black, brown, and American Indian/Alaska Native indigenous people have 3-4x higher rates of pregnancy-related deaths and severe morbidity than their White, non-Hispanic, and Asian/Pacific Islander counterparts. This policy brief explores how expanding evidence based home visiting programs (HVPs) and strengthening reimbursement policies that invest in such programs can be pivoted to optimize the scope of care in the postpartum period.
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Affiliation(s)
- Binh Phung
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States,Department of Epidemiology and Public Health, Yale University, New Haven, CT, United States,Correspondence: Binh Phung
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Behm B, Tevendale H, Carrigan S, Stone C, Morris K, Rosenthal J. A National Communication Effort Addressing Maternal Mortality in the United States: Implementation of the Hear Her Campaign. J Womens Health (Larchmt) 2022; 31:1677-1685. [PMID: 36525044 PMCID: PMC10964150 DOI: 10.1089/jwh.2022.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
More than 700 women die each year in the United States from complications related to pregnancy, and considerable racial and ethnic disparities continue to exist. Recognizing the urgent maternal warning signs of pregnancy-related complications, getting an accurate and timely diagnosis and quality care can save lives. In August 2020, the Centers for Disease Control and Prevention, Division of Reproductive Health launched a national communication campaign called "Hear Her" to raise awareness of urgent maternal warning signs during pregnancy and in the year after pregnancy and improve communication between pregnant or postpartum people and their support systems and health care providers. Storytelling is a central strategy to the campaign, which features video stories of women's experiences with pregnancy-related conditions to bring voices to the statistics and to help motivate action. These stories and additional campaign resources are disseminated through a website, digital media, organic (free) and paid social media, earned media, public service announcement distribution, and partners, with increased outreach to disproportionately affected communities. Partners in maternal and child health played an important role from campaign development to outreach and message dissemination. In the first year of the campaign, there were >390,000 unique visitors to the Hear Her website and 180 million impressions (number of times that content was displayed to a user) from digital and social media. Digital media allowed the campaign to reach priority audiences at a time when news and social media had a number of other urgent public health messages related to the COVID-19 pandemic.
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Affiliation(s)
- Brittany Behm
- Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Tevendale
- Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Carrigan
- Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina Stone
- Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- BeVera Solutions, Riverdale, Georgia, USA
| | - Kelly Morris
- Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jackie Rosenthal
- Center for Global Health Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Carty DC, Mpofu JJ, Kress AC, Robinson D, Miller SA. Addressing Racial Disparities in Pregnancy-Related Deaths: An Analysis of Maternal Mortality-Related Federal Legislation, 2017-2021. J Womens Health (Larchmt) 2022; 31:1222-1231. [PMID: 36112423 PMCID: PMC10949966 DOI: 10.1089/jwh.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There has been increasing national attention to the issue of racial disparities in pregnancy-related deaths. Federal legislation can support approaches at multiple levels of intervention to improve maternal health. As part of the CDC Policy Academy, a team of CDC staff completed a policy analysis to determine the approaches addressed in federal legislation to reduce racial disparities in pregnancy-related deaths. We analyzed federal maternal mortality legislation introduced January 2017 through December 2021. Common approaches addressed by the legislation were categorized into themes and reviewed for their alignment with approaches identified in clinical and public health literature to reduce pregnancy-related deaths, with an emphasis on social determinants of health (SDOH) approaches and reducing racial disparities. Thirty-seven unduplicated bills addressed pregnancy-related deaths, including 27 House or Senate bills that were introduced but not passed, 6 resolutions highlighting the maternal health crisis, 2 bills that passed the House only, and 2 bills enacted into law (Preventing Maternal Deaths Act of 2018 and Protecting Moms Who Served Act). The most common themes mentioned in federal legislation were improving maternal health care, addressing health inequities and SDOH, enhancing data, and promoting women's health. Legislation focused on health inequities and SDOH emphasized implicit bias training and improving SDOH, including racism and other social factors. The reviewed federal legislation reflected common clinical and public health approaches to prevent pregnancy-related deaths, including a significant focus on reducing bias and improving SDOH to address racial disparities.
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Affiliation(s)
- Denise C. Carty
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonetta J. Mpofu
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Alissa C. Kress
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Desireé Robinson
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott A. Miller
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Korbeľ M, Kotríková D, Krištúfková A, Kaščák P, Nižňanská Z. Maternal mortality in the Slovak Republic in the years 2007-2018. Ceska Gynekol 2022; 87:87-92. [PMID: 35667858 DOI: 10.48095/cccg202287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Analysis of maternal mortality in the Slovak Republic in the years 2007-2018. METHODS The analysis of selected maternal mortality data in the years 2007-2018. RESULTS In the years 2007-2018, 84 women died during pregnancy or within 42 days of the end of pregnancy - maternal mortality ratio was 12.57 per 100,000 live births. Direct maternal mortality ratio in this period was 4.64 (31 maternal deaths), indirect maternal mortality 6.74 (45 maternal deaths) and direct obstetrics death ratio was 11.38 per 100,000 live births. Pregnancy-associated but unrelated maternal death ratio was 1.19 (eight maternal deaths). The Slovak Gynecological and Obstetric Society revealed a 64% underestimation of maternal mortality data in comparison with routine statistical data. CONCLUSION Maternal mortality ratio in the Slovak Republic was one of the highest in the European Union and was discordant with a good level of perinatal mortality. In the Slovak Republic, it is necessary to look for ways to reduce maternal mortality and improve data collection.
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Musarandega R, Machekano R, Munjanja SP, Pattinson R. Methods used to measure maternal mortality in Sub-Saharan Africa from 1980 to 2020: A systematic literature review. Int J Gynaecol Obstet 2021; 156:206-215. [PMID: 33811639 DOI: 10.1002/ijgo.13695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gobally, Sub-Saharan Africa (SSA) has the largest maternal mortality burden, but the region lacks accurate data. OBJECTIVE To review methods historically used to measure maternal mortality in SSA to inform future study methods. SEARCH STRATEGY We searched databases: PubMed, Medline, WorldCat and CINHAL, using keywords "maternal mortality," "pregnancy-related death," "reproductive age mortality," "ratio," "rate," and "risk," using Boolean operators "OR" and "AND" to combine the search terms. SELECTION CRITERIA We searched for empirical and analytical studies that: (1) measured maternal mortality levels, (2) were in SSA, (3) reported original results, and (4) were not duplicate studies. We included studies published in English since 1980. DATA COLLECTION AND ANALYSIS We screened the studies using titles and abstracts, reading the full text of selected studies. We analyzed the estimates and strengths, and limitations of the methods. MAIN RESULTS We identified 96 studies that used nine methods: demographic surveillance (n = 4), health record reviews (n = 18), confidential enquiries and maternal death surveillance and response (n = 7), prospective cohort (n = 9), reproductive age mortality survey (RAMOS) (n = 6), sisterhood method (n = 35), mixed methods (n = 4), and mathematical modeling (n = 13). CONCLUSION Sisterhood method studies and RAMOS studies that combined institutional records and community data produced maternal mortality ratios more comparable with WHO estimates.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rhoderick Machekano
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen Peter Munjanja
- Obstetrics and Gynaecology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Robert Pattinson
- Maternal, Fetal, Newborn & Child Health Care Strategies Research Centre, University of Pretoria, Pretoria, South Africa
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Krishnaswami J, Del C Colon-Gonzalez M. Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. Am J Lifestyle Med 2019; 13:495-504. [PMID: 31523215 DOI: 10.1177/1559827619838461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.
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Affiliation(s)
- Janani Krishnaswami
- Internal Medicine / Preventive Medicine, University of Texas Rio Grande Valley. Texas (MDCCG)
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Geller SE, Koch AR, Martin NJ, Rosenberg D, Bigger HR. Assessing preventability of maternal mortality in Illinois: 2002-2012. Am J Obstet Gynecol 2014; 211:698.e1-11. [PMID: 24956547 DOI: 10.1016/j.ajog.2014.06.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/05/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We sought to describe the potential preventability of pregnancy-related deaths in Illinois from 2002 through 2012 as determined by perinatal centers following the Illinois maternal death review process. STUDY DESIGN We conducted a retrospective review of all known maternal deaths in the state from 2002 through 2012 with complete records in the Illinois Department of Public Health's Maternal Mortality Review Form database. The association between causes of death and potential preventability was analyzed for pregnancy-related deaths. RESULTS There were 610 maternal deaths in Illinois during the study period (31.8 per 100,000 live births). One-third of maternal deaths (n = 210) were directly or indirectly related to pregnancy, 7.0% (n = 43) were possibly related, and 52.6% (n = 321) were unrelated. Vascular causes were the most common cause of pregnancy-related death, followed by cardiac causes and hemorrhage. One-third of deaths directly or indirectly related to pregnancy were deemed potentially preventable. Hemorrhage and deaths due to psychiatric causes were most likely to be considered avoidable, while cancer and vascular-related deaths were generally not considered preventable. CONCLUSION This analysis of pregnancy-related deaths in Illinois, the first in >60 years, found similar causes of death and potential preventability as pregnancy-related death reviews in other states. Analyzing the causes of pregnancy-related death is a critical and necessary step in improving maternal health outcomes, particularly in decreasing potentially preventable pregnancy-related deaths. Greater attention should be directed toward intervening on the provider, systems, and patient factors contributing to preventable deaths.
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