DPH: Sharp rise in pregnancy-related illness in Mass. from 2011-2020

The Commonwealth Fund recently ranked Massachusetts tops in the nation when it comes to healthcare -- but a new state report suggests things are far from perfect.

Wednesday, the Department of Public Health released ‘An Assessment of Severe Maternal Morbidity in Massachusetts.’ It found that rates of serious pregnancy-related illnesses nearly doubled between 2011 and 2020 -- going from about 52 incidents per 10,000 births in 2011 to about 100 incidents per 10,000 births in 2020.

“These are stunning numbers in a state that is supposed to have some of the best health care in the world,” said Rebecca Hart Holder, president of Reproductive Equity Now. “We know that there has been a severe maternal health crisis across the country for decades. I think the surprise is how sharp the increase in maternal morbidity is.”

Serious Maternal Morbidities, or SMMs, include pregnancy-related issues with the heart, lungs, kidneys and vascular system. Pre-eclampsia is a well-known complication.

“The symptoms that you see are an elevated blood pressure that is continuous,” said Nawal Nour, MD, MPH, chair of Brigham and Women’s Hospital’s OB/GYN Department. “When we do blood levels, their liver enzymes increase, the platelets might drop. And then patients might say, ‘I see spots in my vision’ and ‘I have the worst headache of my life.’”

The goal with such patients is to keep them from advancing to actual eclampsia, which involves seizures.

“People can end up with eclampsia weeks after delivery,” said Noor, who advocates reconsideration of what is considered the postpartum period.

“Birthing people and mothers are at risk of death and morbidity even after delivery,” Noor said. “In the past we’ve been thinking about the postpartum period as up to six weeks. But in fact we should be thinking much like European countries.”

While the report found serious pregnancy-related illness rose across racial groups, the disparity between white and black women grew by 25 percent. In 2011, black women were twice as likely to end up with a serious complication than white women. That risk rose to 2.5 by 2020.

Noor said part of the problem is systemic racism in medicine -- a situation in which some patients are not taken as seriously as others -- or are just not listened to. That could mean missing important warning signs during a pregnancy that all is not well.

While everyone has biases, Noor suggested that sometimes this lack of listening has little to do with the actual patient.

“It could be the amount of acuity on the labor floor,” said Noor. “It could be the amount of patients that a provider has to see in a session.”

Overall, Noor said she was surprised by the state’s numbers -- because OB/GYN has been focused on reducing maternal morbidity and mortality for years. She was also disappointed.

“Maternal mortality is something that we should be able to prevent,” she said.

“As you compare ourselves with other Western nations we rank the lowest. How is it that other countries are doing so much better than we are?”

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