Accelerating Research to Prevent Maternal Morbidity and Mortality (MMM): At-A-Glance

Accelerating Research to Prevent Maternal Morbidity and Mortality (MMM): At-A-Glance

The United States has the highest maternal mortality ratio (per 100,000 live births)1 of developed countries: United States = 19; Qatar = 9; Japan = 5; Finland = 3; Canada = 10.

In the United States,2 Blacks and American Indians/Alaska Natives (AI/AN) are at highest risk for maternal mortality (deaths per 100,000 live births) in the United States: White = 13; Black = 41; AI/AN = 30; Asian/Pacific Islander = 13; Hispanic = 11. In addition, 700 die and 50,000 are at risk for severe disease from problems that occur during and after pregnancy.

National Institutes of Health (NIH) research has identified risk factors, explored disparities, and developed and tested treatments to improve maternal health and care, but more action is needed to make pregnancy and childbirth safer in the United States.

NIH 2020 MMM Research by the Numbers3

  • Spending: $224 Million
  • Funded Projects: 551
  • Institutes and Centers Involved: 21 (plus the Office of the NIH Director)

NIH 2020 MMM Research Findings

Pre-Pregnancy and Pregnancy Loss

  • NIH launches the Implementing a Maternal Health & PRregnancy Outcomes Vision for Everyone (IMPROVE) initiative to study all aspects of maternal health, including racial/ethnic disparities in MMM.4,5
  • Low-dose aspirin may improve pregnancy and live birth chances for some women, while cannabis and opioid use may reduce pregnancy chances.6,7,8
  • Pre-pregnancy cardiovascular health factors in first-time mothers may increase pregnancy complication risks.9

Pregnancy

  • Gestational Research Assessments for COVID-19 (GRAVID) study10 early findings: Severe COVID-19 disease increases complication risks.
  • Maternal and Pediatric pRecision IN Therapeutics (MPRINT) Hub11 expands pharmacology studies in pregnant and lactating women.
  • Risk of prenatal and postpartum death is significantly higher for women living in maternity care deserts (counties lacking obstetric care hospitals or midwives).12

Labor and Delivery

  • Women in U.S. rural areas are more likely to need blood transfusions during labor and delivery.13
  • Single-dose azithromycin during labor may reduce risk of maternal infections and death in low- and middle-income countries.14
  • Using MRI and specialized software, researchers can track the electrical signals of contractions across the entire surface of the uterus during labor to detect possible problems.15

Postpartum

  • First-ever drug treatment specifically approved for postpartum depression, which research shows may persist for up to 3 years after birth.16,17
  • Risk for postpartum stroke is highest in the first 10 days after giving birth.18
  • In first-time mothers, pregnancy complications double the risk for high blood pressure and other problems later in life.19

Citations

  1. World Health Organization. (2021). Maternal mortality ratio (per 100,000 live births). Retrieved June 14, 2021, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/maternal-mortality-ratio-(per-100-000-live-births) external link
  2. Petersen, E. E. Davis, N. L., Goodman, D., Cox, S., Syverson, C. Seed, K., Sapiro-Mendoza, C., Callaghan, W. M., & Barfield, W. (2019). Racial/ethnic disparities in pregnancy-related deaths – United States, 2007-2016. Morbidity and Mortality Weekly Report, 68(35), 762-765. Retrieved June 14, 2021, from  https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6835a3-H.pdf (PDF 94 KB)
  3. National Institutes of Health. Estimates of funding for various research, condition, and disease categories. (2020). Retrieved June 14, 2021, from https://report.nih.gov/funding/categorical-spending#/
  4. NICHD. (2020). Director’s blog: Push to IMPROVE health outcomes for pregnant people. Retrieved June 14, 2021, from https://www.nichd.nih.gov/about/org/od/directors_corner/prev_updates/IMPROVE
  5. Office of Research on Women’s Health. Director’s message: Toward an improved vision of maternal health and pregnancy outcomes. Retrieved June 14, 2021, from https://orwh.od.nih.gov/about/director/messages/toward-improved-vision-maternal-health-and-pregnancy-outcomes
  6. Naimi, A. I., Perkins, N. J., Sjaarda, L. A., Mumford, S. L., Platt, R. W., Silver, R. M., & Schisterman, E. F. (2021). The effect of preconception-initiated low-dose aspirin on human chorionic gonadotropin-detected pregnancy, pregnancy loss, and live birth: Per protocol analysis of a randomized trial. Annals of Internal Medicine, 174(5), 595–601. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33493011/
  7. Mumford, S. L., Flannagan, K. S., Radoc, J. G., Sjaarda, L. A., Zolton, J. R., Metz, T. D., Plowden, T. C., Perkins, N. J., DeVilbiss, E. A., Andriessen, V. C., A C, P. S., Kim, K., Yisahak, S. F., Freeman, J. R., Alkhalaf, Z., Silver, R. M., & Schisterman, E. F. (2021). Cannabis use while trying to conceive: a prospective cohort study evaluating associations with fecundability, live birth and pregnancy loss. Human Reproduction (Oxford, England), 36(5), 1405–1415. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33421071/
  8. Flannagan, K. S., Sjaarda, L. A., Mumford, S. L., & Schisterman, E. F. (2020). Prescription opioid use among populations of reproductive age: Effects on fertility, pregnancy loss, and pregnancy complications. Epidemiologic Reviews, 42(1), 117–133. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33001215/
  9. Kominiarek, M., … NHLBI nuMoM2b Heart Health Study (2021). Early pregnancy atherogenic profile in a first pregnancy and hypertension risk 2 to 7 years after delivery. Journal of the American Heart Association, 10(5), e017216. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33619977/
  10. Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G., Saade, G. R., Grobman, W. A., Manuck, T. A., Miodovnik, M., Sowles, A., Clark, K., Gyamfi-Bannerman, C., Mendez-Figueroa, H., Sehdev, H. M., Rouse, D. J., Tita, A., Bailit, J., Costantine, M. M., Simhan, H. N., Macones, G. A., & Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network (2021). Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstetrics and Gynecology, 137(4), 571–580. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33560778/
  11. NICHD. Maternal and Pediatric pRecision IN Therapeutics (MPRINT) Hub. Retrieved June 14, 2021, from https://www.nichd.nih.gov/about/org/der/branches/opptb/mprint
  12. Wallace, M., Dyer, L., Felker-Kantor, E., Benno, J., Vilda, D., Harville, E., & Theall, K. (2021). Maternity care deserts and pregnancy-associated mortality in Louisiana. Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health, 31(2), 122–129. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33069560/
  13. Hartenbach, E. M., Kuo, H. D., Greene, M. Z., Shrider, E. A., Antony, K. M., & Ehrenthal, D. B. (2020). Peripartum blood transfusion among rural women in the United States. Obstetrics and Gynecology, 135(3), 685–695. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/32028506/
  14. NIH. (2020). News release: NIH to test one-dose antibiotic for the prevention of maternal and infant sepsis. Retrieved June 14, 2021, from https://www.nih.gov/news-events/news-releases/nih-test-one-dose-antibiotic-prevention-maternal-infant-sepsis
  15. Wang, H., Wu, W., Talcott, M., McKinstry, R. C., Woodard, P. K., Macones, G. A., Schwartz, A. L., Cuculich, P., Cahill, A. G., & Wang, Y. (2020). Accuracy of electromyometrial imaging of uterine contractions in clinical environment. Computers in Biology and Medicine, 116, 103543. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/31786490/
  16. NIH. (2019). Media advisory: Bench-to-bedside: NIMH research leads to brexanolone, first-ever drug specifically for postpartum depression. Retrieved June 14, 2021, from https://www.nih.gov/news-events/news-releases/bench-bedside-nimh-research-leads-brexanolone-first-ever-drug-specifically-postpartum-depression
  17. Putnick, D. L., Sundaram, R., Bell, E. M., Ghassabian, A., Goldstein, R. B., Robinson, S. L., Vafai, Y., Gilman, S. E., & Yeung, E. (2020). Trajectories of maternal postpartum depressive symptoms. Pediatrics, 146(5), e20200857. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33109744/
  18. Too, G., Wen, T., Boehme, A. K., Miller, E. C., Leffert, L. R., Attenello, F. J., Mack, W. J., DʼAlton, M. E., & Friedman, A. M. (2018). Timing and risk factors of postpartum stroke. Obstetrics and Gynecology, 131(1), 70–78. Retrieved June 14, 2021, from https://www.ncbi.nlm.nih.gov/pubmed/29215510
  19. Haas, D. M., Parker, C. B., Marsh, D. J., Grobman, W. A., Ehrenthal, D. B., Greenland, P., Bairey Merz, C. N., Pemberton, V. L., Silver, R. M., Barnes, S., McNeil, R. B., Cleary, K., Reddy, U. M., Chung, J. H., Parry, S., Theilen, L. H., Blumenthal, E. A., Levine, L. D., Mercer, B. M., Simhan, H., … NHLBI nuMoM2b Heart Health Study (2019). Association of adverse pregnancy outcomes with hypertension 2 to 7 years postpartum. Journal of the American Heart Association, 8(19), e013092. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/31564189/

 

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