Report: More complications seen in county’s pregnancies

Life-threatening, pregnancy-related complications — the iceberg beneath the surface of the U.S. maternal health crisis — are on the rise in Harris County, according to a new report.

The report not only confirmed the Harris County rate is worse than that of the state and nation, it found that it increased more than 50 percent between 2008 and 2015. Texas’ rate of lifethreatening, pregnancy-related complications went up 15 percent in the same time period.

“In subtle and unintentional ways, women’s health in Harris County has been subjugated to the health of babies so profoundly that the health of women of childbearing age is often not prioritized,” says the report, a project of the Houston Endowment.

Dr. Lisa Hollier, a Houston obstetrician-gynecologist and a co-chair of the task force that produced the report, said Harris County’s high rates “point to the need for greater intervention to promote safety around the time of delivery. Such complications are 50 times more common than pregnancyrelated deaths, but don’t get near the amount of attention.”

Hollier and Dr. Cecilia Cazaban, the report’s principal investigator, said it is unclear why Harris County’s rate is increasing at such a high rate. They said that analysis is next on tap for the task force.

The report comes amid much consternation about maternal health problems in Texas and the nation, most involving deaths from pregnancy until 42 days after delivery. Recent statistics

have shown the U.S. numbers are considerably greater than other Western nations.

Texas was thought to be the nation’s worst for pregnancy deaths, but two weeks ago a study showed its numbers aren’t nearly as bad as previously reported. That new data found the number of maternal deaths is less than half that reported in a 2016 study that shone a spotlight on Texas. The data put Texas in the middle among U.S. states, still unacceptable, said experts.

The new report focuses on severe maternal morbidity, the term for conditions that require such treatment as a respirator or blood transfusions or hysterectomy during delivery or in the hours thereafter. It can lead to maternal death, but even when the patient survives, it can cause damage, such as kidney or heart failure, sometimes requiring lifelong treatment. It also is costly to the patient and health care system.

Harris County’s rate of severe maternal morbidity in 2015 was 2.4 percent, meaning there were 238 cases for every 10,000 deliveries. The 2015 rate was 1.97 in Texas and 1.46 in the United States.

The report found many of the same risk factors previously identified in maternal mortality investigations, such as high blood pressure, diabetes, obesity and mental illness. The highest rates of lifethreatening complications came in black women, Medicaid recipients, mothers in their early teens and over 40, and those with other underlying conditions.

One such woman is Kay Matthews, who gave birth to a stillborn daughter, then fought the emotional toll.

“Doctors just said, ‘It’s OK, we’ll monitor it,’ when I told them things weren’t right late in the pregnancy, when I had issues with bleeding and cramping,” said Matthews, who went on to found Shades of Blue, an organization dedicated to helping minority women with postpartum depression or anxiety.

“I received no answers about why I lost the baby, and there was no follow-up. I had to find a mental health counselor myself,” Matthews said.

The report found that “the high rate of disparities in care and outcomes for black women is driven in part by implicit bias around women, income and race that is endemic throughout the health care system.”

Matthews was part of a focus group that spoke with the task force, whose report include a few quotes from women who’d undergone difficult pregnancies. One said, “If you have private insurance (the doctor) will sit and talk with you … but if you are on Medicaid, it’s just in and out.”

The report also said that “barriers to enrollment in publicly funded insurance and confusion about insurance coverage play a detrimental role in maternal health” and that “in Harris County, reproductive health has become disconnected from women’s general health such that it is often not included in women’s regular primary care, limiting their access to critical services.”

Cazaban, a professor at the University of Texas School of Public Health, said Harris County’s severe maternal morbidity increases involved acute renal failure, adult respiratory distress syndrome, heart failure, sepsis and conditions requiring blood transfusions.

Opioid addiction was a cause of increase in Dallas County and the Panhandle, but not in Harris County, according to the report.

It provided nine recommendations to improve maternal health, including creating a public awareness campaign to prioritize pregnant women’s own health, encouraging providers to adopt best practices for maternal health, and funding partnerships between providers and communities to ensure support for during and after pregnancy.

“This report provides a much better understanding of some of the most important contributors to adverse outcomes for women,” said Hollier, who works at Baylor College of Medicine and Texas Children’s Hospital. “The next step is, ensure better access to care.”

todd.ackerman@chron.com twitter.com/chronmed