Troubling spike in serious pregnancy-related complications for all ages in Illinois

A new study from Northwestern Medicine reveals a disturbing increase in serious maternal health problems and birth complications in Illinois from 2016 to 2023, closely tied to an increase in chronic health conditions that affect pregnancy, such as high blood pressure, gestational diabetes, mental disorders and especially obesity, where the annual figures showed the largest increase.

The study highlights significant racial and socioeconomic disparities, finding that non-Hispanic black mothers experienced more than double the rate of serious complications compared to non-Hispanic white mothers, and that living in high-poverty neighborhoods increases health risks for mothers increased in all racial groups.

“Despite significant recent statewide quality improvement efforts, these birth outcomes are worsening for all ages, reflecting the deteriorating health of Illinois' reproductive-age population before pregnancy,” says corresponding author Dr. Mugdha Mokashi, a doctor of obstetrics and gynecology at Northwestern's McGaw Medical Center.

The findings reflect national trends showing the increasing prevalence of conditions such as obesity, hypertensive disorders of pregnancy and gestational diabetes among pregnant people of all ages, she added. The study provides the most current data on maternal morbidity and delivery complications in the state of Illinois.

The findings were published November 21 in the news O&G opened.

“Our findings underscore the role of social determinants of health – such as race and income – in driving disparities in maternal health, suggesting that efforts to reduce maternal morbidity must address both racial disparities and economic hardship,” said study co-author Dr. Lynn Yee, associate professor of obstetrics and pulmonary diseases at Northwestern University Feinberg School of Medicine and a maternal-fetal medicine physician at Northwestern Medicine.

Breakdown of the findings

In the study cohort of 988,480 births in 127 hospitals in Illinois between January 2016 and June 2023, the overall rate of severe maternal morbidity increased from 1.4% in 2016 to 2% in 2023. Vaginal birth complications increased 22.4%, and cesarean birth complications rose by 48.9%. %.

Hypertensive disorders of pregnancy and anemia – both of which increased over the study period – were significant risk factors for severe maternal morbidity and birth complications. The largest increase occurred in annual obesity rates from 2016 to the first six months of 2023 (7.8% to 22.3%).

In addition, there were increases in gestational diabetes (4.2% to 5.5%), depression (2.5% to 6.6%), anxiety (3.1% to 10.4%), and other chronic comorbidities (4, 7% to 7.4%). Non-Hispanic black patients had more than double the rate of severe maternal morbidity (2.6%) compared to non-Hispanic white patients (1.1%).

Health advice before pregnancy is important

Maternal health affects almost everyone, and those thinking about pregnancy should definitely contact their healthcare provider to screen for any chronic conditions before becoming pregnant, the study authors said.

“Pre-conception counseling is such an important way to ensure that all your health concerns are optimized before pregnancy,” Mokashi said. “There are many important policy and public health initiatives in Illinois that people may want to learn more about.”

'It's not just because the people who get pregnant are older'

Although this was not the original purpose of the study, the scientists conducted additional analyzes that showed that the increased prevalence of maternal health problems and birth complications is not simply due to the fact that the people who become pregnant are older. The findings reflected an increase in hospital coding for hypertensive disorders during pregnancy, gestational diabetes, anemia, depression, severe mental illness and other chronic conditions, especially obesity, even among those who gave birth and were younger than 30 years.

“In short, even young pregnant patients have more medical conditions and complications during pregnancy,” Mokashi said.

What can be done?

Anti-poverty policies — such as Illinois' proposed refundable child tax credit, House Bill 4917, if passed — have shown improvements in maternal health, the study authors said.

Perinatal quality initiatives in California have reduced morbidity associated with postpartum hemorrhage. Similarly, the Illinois Perinatal Quality Collaborative is working to reduce cesarean sections and address racial disparities by promoting vaginal birth and birth equity initiatives.

Increasing access to doula support and patient navigator programs could also be helpful support, Mokashi said. In 2024, the Illinois Department of Healthcare and Family Services adjusted reimbursement for doula services. At Northwestern, research on patient navigator programs has shown promise in reducing disparities in care for low-income, postpartum patients. And at the federal level, passage of the 13 bills that include the Black Maternal Health Momnibus Act, which was reintroduced in 2023, would provide critical funding support to increase data collection and quality initiatives for maternal death prevention.