For the last several years, the maternal mortality rate has been declining throughout the world. That’s the good news. The bad news is that, surprisingly, the maternal mortality rate continues to rise in the United States.
That’s why the Jewish Healthcare Foundation has approved a three-year, $600,000 grant to support the development of a Women’s Health Research and Policy Center at the RAND Corporation in a collaboration with Magee-Womens Research Institute.
As cardiovascular disease is a leading cause of death among pregnant women, the new center aims to advance the understanding of women’s cardiovascular health in pregnancy and to ultimately improve the quality of care and outcomes.
The $600,000 grant is “part of a much bigger initiative,” said Karen Wolk Feinstein, president and CEO of the JHF.
That larger initiative is the Women’s Health Activist Movement (WHAMglobal), founded in 2016 by the JHF in collaboration with the national organization Women of Impact. WHAMglobal works to identify the root causes of maternal mortality and to supporting mothers and families through the entirety of their care.
“We’re looking at the really tragic and somewhat puzzling high rate of maternal mortality in the United States — higher than any other developed country, but also sadly trending upward whereas everyone else is trending down,” Feinstein said. “So, when you’re focused on maternal mortality, of course, you look at the causes. Why would a young and sometimes quite healthy mother die as a result of pregnancy? And the No. 1 medical reason is cardiovascular disease.”
An objective of WHAMglobal is to improve the early detection of cardiovascular disease and to examine “why pregnancy sometimes exacerbates the problem or creates the problem,” Feinstein said.
Bringing together the strengths of RAND and Magee-Womens Research Institute, the new Women’s Health Research and Policy Center will work to develop a series of proposals for the National Institutes of Health and other funders related to women’s cardiovascular health during and after pregnancy. The center will focus on research that can be translated into best practices for cardiovascular health care for pregnant women, and on addressing gaps in care.
“That has to do with how mothers get cared for … prior to pregnancy, during pregnancy, and post-natal,” Feinstein said. “The consequences of pregnancy can reveal themselves anywhere in the first year post-natal. And where cardiovascular disease is concerned, it may mean a lifetime of diligence. So, the research aspect of it is critical and we have a great opportunity here, because both through RAND and their researchers, and of course Magee-Womens and their research institute — where there are also outstanding researchers in this area — we thought what a wonderful partnership.”
In the United States, of the 5,259 deaths within a year of pregnancy completion that occurred during 2011-2013 and were reported to the Centers for Disease Control and Prevention, 2,009 were found to be pregnancy related.
There are considerable racial disparities in pregnancy-related mortality, according to the CDC. During 2011-2013, the pregnancy-related mortality ratios in the United States were 12.7 deaths per 100,000 live births for white women; 43.5 deaths per 100,000 live births for black women; and 14.4 deaths per 100,000 live births for women of other races.
Of those pregnancy-related deaths, 15.5 percent were attributed to cardiovascular diseases and 14.5 percent were attributed to noncardiovascular diseases.
“Our interest overall is to understand better the role that cardiovascular disease plays in pregnancy and the role that pregnancy plays in bringing forward cardiovascular complications,” said Feinstein.
Last April, the JHF organized a trip to Australia to observe best practices there. The maternal mortality ratio in Australia, between 2008 and 2012, was 7.1 deaths per 100,000 women who gave birth.
“What we observed was that both the women’s hospitals and the child development centers were so first class,” Feinstein said. “It was so extraordinary and modern. The facilities were just excellent. The people who lead the teams were exemplary. They take a very comprehensive approach to pregnancy in Australia; the women are assessed over and over again during pregnancy and afterward to make sure that people are on a healthy continuum.
“They are very focused on the mother-infant attachment afterward, so they look at the whole family unit very comprehensively, and because they do such rigorous assessments when any woman or family presents themselves as being at-risk, a whole level of intervention that just awed us goes into effect,” she continued. “So, once you are determined to be at risk, or the family unit is at risk, or the infant is at risk, immediately you are connected to a whole host of services and volunteers.” PJC