Improving maternal and infant health is a national priority

Sept. 6, 2019
Maternal mortality is down but severe morbidity is on the rise

Maternal mortalities in the hospital at the time of delivery have decreased by 24 percent over the past decade, according to a nationally representative analysis of U.S. hospital data by group purchasing organization Premier Inc. The disparity gap for black women and all other races narrowed over time, finding an 80 percent decrease in black mothers experiencing in-hospital, delivery-related mortalities.

However, severe maternal morbidities increased, pointing to needed changes in women’s healthcare both pre- and post-partum. Also, the maternal population is aging and more expecting mothers across age groups are suffering from substance misuse.

The Premier analysis, which explored maternal and infant health outcomes at the time of delivery, leveraged the Premier Healthcare Database and included standardized inpatient data from 8.9 million births (approximately 25 percent of births nationally) that occurred in 903 hospitals across 45 states between 2008-2018.

“Improving maternal and infant health is a national priority,” said Susan DeVore, CEO of Premier. “Premier’s analysis clearly shows the significant progress made by hospitals to reduce disparities and maternal death. It is imperative that mothers get to the hospital to safely deliver their babies or if complications arise. This analysis provides additional insights into policy and clinical actions that should be taken to address maternal and infant health across the care continuum. It also underscores the critical need to better integrate care delivery between the hospital and pre- and post-care services for mothers and their newborns, as well as to better manage high-risk complications.”

Premier’s analysis identified a 36 percent increase in severe maternal morbidity (SMM) rates, including a 79 percent higher SMM rate for black women than white women. Women with commercial insurance had the lowest SMM rates. SMM, as measured by the CDC, includes unexpected outcomes of labor and delivery that result in significant short- or long-term health effects, including eclampsia, cardiac arrest and sepsis.

The increase in SMM rates could be due to several factors, such as changes in coding, age, race, payer, type of delivery, substance misuse, region and hospital type. Potential multifactorial causes of increasing SMM rates require additional detailed analyses, which Premier plans to conduct. For example, there is a clear correlation between increased rates of SMM and the transition from ICD-9 to ICD-10 coding in 2015. The changes in ICD-10 coding may demonstrate a capability to identify additional complications and SMM at a greater level of accuracy, enabling a better understanding of preventable harm and complications associated with pregnancy.

Furthermore, the Premier analysis confirmed a higher risk of SMM and mortality is associated with women who receive lifesaving blood transfusions as a result of pregnancy-related complications, with black women receiving significantly higher rates of transfusions.

“Premier’s distinctive insights into the current state of maternal mortality in the United States are a clear indication of the steps hospitals have taken to improve maternal care,” said Andrew J. Healy, MD, Medical Director of Obstetrics at Baystate Health, a member of the Premier Perinatal Collaborative. “However, there is room for improvement, especially when it comes to addressing the increasing SMM rates as identified in the analysis. That is why hospitals must focus on sharing data and best practices transparently, with other health systems, in order to establish a systemwide model of care for mothers and their newborns. It is imperative to measurably close gaps across the care continuum to minimize the risk for severe complications and death as a result of pregnancy.”

Additionally, the analysis confirmed that more women are having babies at an older age. Specifically, women giving birth who are older than 35 years of age increased by 24 percent and by 12 percent for mothers 25-35. Women giving birth younger than 25 decreased by 29 percent.

Premier’s analysis also explored the impact of substance misuse on maternal and infant health, pinpointing a 153 percent increase in mothers with substance use disorders and a 140 percent increase in babies born with neonatal abstinence syndrome.

This is Premier’s first analysis on maternal and infant mortality and morbidity, which was conducted as part of its Bundle of Joy campaign. The campaign is designed to test and scale measurable improvement in the quality, safety and cost of care for mothers and babies in the U.S. Premier plans to conduct additional analyses on the key drivers of maternal and infant mortality and morbidity, as well as the costs associated with these trends, which will serve as a baseline for measuring hospital improvement.

Premier noted also that a new report released by the Centers for Disease Control & Prevention (CDC), “Racial/Ethnic Disparities in Pregnancy-Related Deaths,” is a clear indication of the critical need to better integrate care delivery between the hospital and pre- and post-care services for mothers and their newborns, as well as to better manage high-risk patients.

While the CDC data pertains to the all pregnancy-related deaths, Premier says its analysis highlights inpatient-related maternal mortality, at the time of delivery.