November 07, 2019
The numbers are in for maternal and infant health, and unfortunately the United States as a whole and Texas, in particular, do not score well. For the fourth year in a row, the U.S. rate of prematurity has gone up. Moreover, the U.S is one of the most dangerous countries in the developed world to have a baby. Our rate of maternal mortality has steadily increased to 16.9 pregnancy-related deaths per 100,000 live births as of 2016 – the latest available CDC data.
As measured by the March of Dimes, the United States received a prematurity grade of C and Texas received a grade of D for our preterm birth rate of 10.8 percent. The state’s rate is up slightly from last year’s 10.6 percent and has been creeping up since the low of 10.2 percent in 2015. The numbers are even worse in Harris County, where the current preterm birth rate is 11.1 percent– actually an improvement over last year’s rate. Racial and ethnic disparities continue to be a challenge; black women in the United States have a prematurity rate that is 49% higher than all other women.
Although the majority of U.S. babies are born at term, preterm infants have the highest rates of morbidity and mortality. The cost of preterm birth (all preterm gestational ages) is estimated to be ~$65,000 per baby—taking into consideration maternal delivery costs, medical care for preterm infants and children, early intervention services, and lost productivity. These are sobering statistics to consider during National Prematurity Awareness Month.
Several states, including Texas, support perinatal quality collaboratives, working together to improve the quality of care for mothers and babies. The aim is to reduce severe pregnancy complications, reduce preterm births, reduce the C-section rate in low-risk women, and reduce racial and ethnic disparities.
The March of Dimes, through their new Birth Equity initiative, is working to address the social determinants of health and health disparity. In Texas, 24.4% of women ages 15-44 are uninsured; 21.6% have inadequate prenatal care; and 16.8% live in poverty—contributors to adverse health outcomes.
The March of Dimes supports several initiatives to change the tide of preterm birth and maternal death in the United States, including comprehensive Medicaid coverage extension for all women for at least one year postpartum, group prenatal care with enhanced reimbursement, and maternal mortality review committees to understand and address the causes of maternal death. In addition, the March of Dimes has supported 6 transdisciplinary research centers dedicated to ending prematurity. These 6 centers (Stanford University; Washington University in St Louis; University of Pennsylvania; University of Chicago-Northwestern-Duke University; Imperial College London; and an Ohio Collaborative) are using innovative approaches to address the problem of preterm birth.
We are fortunate at UT to have March of Dimes and Moore Foundation support for a unique Center for Perinatal Safety, led by Dr. KuoJen Tsao, professor of pediatric surgery, and colleagues. The Center is using evidence to build a culture of safety to improve care and outcomes for mothers and babies and hopes to serve as a national model.
A special thank you to our Departments of Obstetrics, Gynecology and Reproductive Sciences and Pediatrics and their Divisions of Maternal Fetal Medicine and Neonatology. Faculty and staff are working every single day to improve outcomes for mothers and babies through clinical care, education, research, and advocacy for women and babies.
As a mother, a neonatologist, and a member of the March of Dimes Maternal and Child Health Advisory Council, the outcomes of mothers and babies are very personal to me. Every woman and every baby matters. Pregnancy and childbirth should be a joyous and safe experience for women, babies, families, and health care providers. Let’s continue to work to make this a reality for all families.