March of Dimes gives Ky. D-minus for high rate of pre-term births; maternal deaths spike; new collaborative will work on such issues

By Melissa Patrick
Kentucky Health News

Childbirth, which should be one of life’s most joyous occasions, has become more deadly for Kentucky mothers, and remains problematic for many Kentucky babies because it comes too early.

One in nine Kentucky babies are born prematurely, so many that the March of Dimes gave the state a D-minus on its 2019 Premature Birth Report Card. And the rate of Kentucky women who died as a result of pregnancy complications nearly doubled from 2017 to 2018.

A baby is premature if born before 37 completed weeks of pregnancy, which is four weeks short of full term. In 2018, Kentucky had 6,109 pre-term births, 11.3 percent of live births. The national average is 10%, a rate that has risen four years in a row.

Because important growth and development happens in the last weeks of pregnancy, pre-term babies are at an increased risk of neurological disorders, intellectual disabilities, and respiratory and digestive problems. They are also more likely to have vision and hearing problems. Complications from being born early is the main overall cause of newborn death, the March of Dimes says.

Pre-term babies are also more at risk for long-term challenges, including chronic diseases such as heart disease, high blood pressure and diabetes, says University of Kentucky HealthCare.

November is Prematurity Awareness Month. The cause of about half of premature births is unknown, but the March of Dimes says there are common risk factors, the strongest being a history of pre-term birth, multiple pregnancy and certain uterine or cervical conditions.

Other factors in the mother that can increase risk include being underweight or overweight, diabetic or older than average for a mother; smoking or using drugs during pregnancy; or having preeclampsia, a type of high blood pressure that some women get during or right after pregnancy.

Kentucky has one of  the highest rates of smoking during pregnancy in the nation, with nearly 18% of pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 6.9%, according to the United Health Foundation‘s health rankings.

This year’s March of Dimes report also looks at several factors that are linked to adverse maternal and infant health outcomes, such as whether a mother has health insurance or prenatal care or if they live in poverty. It also looks at racial disparities in pre-term birth, beyond the aforementioned factors.

In Kentucky, 7% of women between 15 and 44 were uninsured, and 18.6% of them lived in poverty. Among those who were pregnant, 14% received inadequate prenatal care. The pre-term birth rate among African American women in Kentucky is 30% higher than the overall state rate.

In addition to the increasing rates of pre-term birth, the report notes that more than 22,000 babies a year in the U.S. die before their first birthday. That’s about two babies every hour.

Number of maternal deaths nearly doubles

The report also says that a woman in the U.S. dies from pregnancy complications about every 12 hours, and more than 60% of those deaths are preventable.

Kentucky’s maternal mortality rate nearly doubled in 2018, said Dr. Connie White, deputy commissioner for clinical affairs in the state Department for Public Health. In 2017, the state had 39 maternal deaths, with substance abuse a factor in 62% of them; in 2018, that number increased to 76, with at least half related to substance abuse, according to death certificates.

White said the state is still reviewing patients’ medical records for 2018, but the numbers are evidence that “We are failing as a system” of delivery hospitals and providers, which should prompt all to ask where that failure exists.

To tackle these problems, the state recently launched the Kentucky Perinatal Quality Collaborative. It will work toward reducing premature births, maternal mortality and neonatal abstinence syndrome, and improving maternal and infant health outcomes. “Perinatal” refers to care given before and after the birth of a child.

White said the collaborative will ask key questions: “Are we not getting people into treatment? Are we not connecting them?” she asked. “Are we not following up afterwards? Are we working with women who have had their children taken away from them? What are we doing to really wrap our arms around these women?”

White said the collaborative will also look at data and recommendations from a new Maternal Mortality Review Committee to create evidence-based interventions that all providers and delivery hospitals can implement.

“This quality collaborative can now take those recommendations and we hope start making inroads into decreasing Kentucky’s maternal death rate,” she said, adding later, “There are evidence-based things that we can do, but we need to all be rowing in the same direction.”

The collaborative is funded by a three-year grant from the federal Centers for Disease Control and Prevention. White said there was a great “pent-up” need for this collaborative, shown by 78% of the state’s 46 birthing hospitals being represented at the collaborative’s Oct. 22 launch in Louisville. Those hospitals represented 91% of the state’s births.

White said the state is applying to become part of the Alliance for Innovation on Maternal Health program, which has created “bundles” of evidence-based protocols and training modules to address many of the problems that contribute to poor maternal and child outcomes, such as hypertension, hemorrhage, and maternal opioid use. After the state becomes part of the program, these bundles would be available to all of the state’s providers and delivery hospitals.

She noted that six counties in Kentucky offer the Sobriety Treatment and Recovery Teams program to help parents with addictions to keep their children out of foster care while keeping the child safe. The counties with START are Kenton, Jefferson, Boyd, Martin, Daviess and Fayette.