Study: Alarming number of moms don’t get prenatal care

Alarming percentages of pregnant women between Houston and Galveston receive no prenatal care, according to a new report that shows a dramatic variance in maternal risk factors in Texas.

The report, which also looked at pre-pregnancy obesity and smoking during pregnancy, found that 14 percent to 16 percent of women who delivered babies in 2015 in areas such as Santa Fe, Hitchcock, Webster and League City did not get prenatal care. During the same period, the state and national averages were 2 percent and 1.6 percent, respectively.

“A number of areas throughout the state have problems, but we really need to work on getting women into prenatal care more in those Houston-Galveston areas,” said Dr. David Lakey, former Texas health commissioner and current vice chancellor for health affairs at the University of Texas System, which produced the report. “People tend to take on aspects of their environment.”

Lakey added that the report and accompanying maps show the three risk factors are widespread in pockets around the state. They include high obesity rates in the San Antonio and border areas, and high smoking rates in numerous rural areas, many in ZIP codes ranging from northeast of Houston to Beaumont.

The UT System report is the second in a series providing health data by ZIP codes. The

first, released in January, found some ZIP codes where a disturbing number of babies were dying before their first birthday. Lakey said the reports still to come will concern life expectancy and maternal morbidity, the term for life-threatening pregnancy complications.

Obesity, smoking and a lack of prenatal care are key risk factors for poor outcomes in the birth process, both for mother and baby. Long overshadowed by the attention paid to the health of the infant, maternal health has become a great concern in recent years as numerous studies have found rates of pregnancy-related deaths and life-threatening complications are higher in Texas and the nation than other Western countries.

The Texas rate was thought to be the worst in the nation, but a study this spring showed the state’s numbers aren’t nearly as bad as previously reported. The new number of maternal deaths, less than half that reported in a 2016 study that shone a spotlight on the state, ranks Texas in the middle among U.S. states.

Still, the levels are considered unacceptable by Texas experts on maternal health, many of whom are working to reduce the numbers as part of a state task force on the problem. Dr. Lisa Hollier, a Baylor College of Medicine obstetrician-gynecologist and the chairwoman of the task force, said she is “glad UT researchers produced these maps.”

‘No real surprises’

“Seeing distributions of risk factors like this helps us see local solutions to reduce maternal mortality,” said Hollier. “Appreciating the variations across the state is important because it suggests that different communities may require different focuses for their initiatives.”

Dr. Sean Blackwell, chairman of obstetrics, gynecology and reproductive sciences with McGovern Medical School at UTHealth in Houston, acknowledged “there are no real surprises in the report,” but called it “valuable to validate what experts think.”

“Go and look at underserved neighborhoods and you’d expect them to match up with these results,” said Blackwell, also chief of obstetrics and gynecology at Children’s Memorial Hermann Hospital. “The next step is to correlate this data with outcomes, such as maternal mortality, infant mortality, premature births and infections and sepsis.”

The report was produced using 2015 birth records. It breaks down each risk factor by ZIP code and ethnicity.

In 5 percent of ZIP codes with at least 100 births, more than 10 percent involved a mother who did not receive any prenatal care before birth. In Harris County, the percentage born to black women with no documented prenatal care ranged from 0 percent to 10.1 percent.

At least 8 percent of pregnant women did not receive prenatal care in all of the ZIP codes in areas from Pearland to the north, Alvin to the west, Texas City and San Leon to the east, and everything but Galveston Island to the south.

Obesity and smoking

The prevalence of pre-pregnancy obesity ranged from 10 percent in some ZIP codes to more than 40 percent in others, including some in the Houston area. In Bexar County, the percentage of babies delivered by Hispanic women classified as morbidly obese prior to becoming pregnant ranged from a low of 1.1 percent to a high of 9.3 percent.

Smoking during pregnancy, associated with premature birth, low birth weight and some birth defects, is generally low in Texas. But the report showed pockets of high rates — infants had been exposed to prenatal maternal smoking in 12 percent of ZIP codes. In one ZIP code, more than 25 percent of pregnant women smoked.

Smoking rates among pregnant women were far lower within cities than rural areas, the report found, a phenomenon Lakey partly attributed to municipality anti-smoking ordinances.

“There’s no silver bullet for improving maternal health in Texas,” said Lakey. “It requires a range of approaches, informed by data and evidence unique to very localized areas. This work should assist those efforts.”