Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Medical Complications During Pregnancy

Summer 2004

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Size of the Problem

There are over 68,000 births annually in Minnesota and over 1,096,832 women of childbearing age (15 to 44 years old) in the state [1]. Based on national estimates, medical complications during pregnancy range between 12% and 27% of all U.S. deliveries [2]. At a minimum, this would represent over 8,000 pregnancies in Minnesota annually.

Seriousness

People affected by medical complications during pregnancy. Nationally, the most frequently reported maternal medical complications include: pregnancy-induced hypertension (3.6% of pregnancies); diabetes (2.6%); anemia (2%); and chronic hypertension (0.7%) [3]. Hospitalization and bedrest may be prescribed to reduce poor pregnancy outcomes associated with uncontrolled hypertension or diabetes. The most common cause of prenatal hospitalization is preterm labor followed by hypertension, diabetes, bleeding/ placenta previa, and premature rupture of the membranes [2].

Diabetes during pregnancy increases the risk for adverse maternal and infant outcomes such as congenital anomalies, cesarean delivery, macrosomia, and future metabolic abnormalities [4]. Studies have also implicated the co-morbidities of obesity and diabetes during pregnancy with increased rates of congenital defects [5].

Minnesota’s data on the rates of medical complications during pregnancy are from two sources: pregnant women on Medical Assistance and WIC Program participants. The Minnesota Pregnancy Assessment Form was used with over 54,000 pregnancies during the period from 1998-2001 [6].

The CDC Pregnancy Nutrition Surveillance System collects prenatal and postpartum data on women and their infants who participate in the Women, Infants and Children Nutrition Program (WIC) and prenatal clinics funded by the Maternal and Child Health Block Grant. These data indicate that anemia continues to be a problem among low-income pregnant women [7]. The Pregnancy Nutrition Surveillance System reports anemia rates for Minnesota WIC mothers as follows:

  • First Trimester - 5.1% anemic
  • Second Trimester - 7.9% anemic
  • Third Trimester - 33.3% anemic
  • Postpartum - 28.3% anemic.
Medical Complications During Pregnancy, Minnesota Public Program Participants 1998-2001
Medical Complication Percent
Diabetes
1.6%
Hypertension Preeclampsia
1.6%
Anemia
2.8%
Source: DHS Mn Pregnancy Assessment Form, 1998-2001. 2003
N=54,309 pregnant women on Medical Assistance/MNCare

Disparities
Higher rates of diabetes and gestational diabetes were reported in studies of American Indian pregnant women in Minnesota.8 American Indian pregnant women in Minnesota have a diabetes-complicated rate of 93 per 1,000 live births. This rate is three times higher than the non-Hispanic white rate [9]. Rates of diabetes complicated births increased with increasing age among American Indian mothers during the study period of 1993-1998.

Economic
The cost-effectiveness of intensive diabetes management before conception and prenatally was found in one California study to save $5.19 for every dollar spent on the program (1990 dollars) [10].

Interventions

Nationally, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have collaborated in preparing and publishing Guidelines for Perinatal Care which specifically address screening and intervention that should be done as a part of quality prenatal care [11].

Minnesota has also benefited from having local standards of prenatal care developed by the Institute for Clinical Systems Improvement [12]. These standards of prenatal care have a strong emphasis on early identification and treatment of medical complications found in pregnancy.

Essential to reducing medical complications of pregnancy is providing women access to pre- and inter-conceptional health care and/or ongoing primary preventive care for all women of childbearing age [13].

Effectiveness of Interventions
Studies have documented the effectiveness of intervention programs for diabetes control during pregnancy and other medical complications during pregnancy [4,10,12].

Status

Minnesota Resources
Public health has programs and strategies that promote identification and reduction of medical complications during pregnancy including:

  • Public health nurse home visiting programs
  • WIC programs statewide
  • Local public health Improved Pregnancy Outcomes (IPO) programs
  • Twin Cities Healthy Start
  • Health Plan Perinatal programs
  • Metro Maternity Case Management Project
  • Culturally-specific programs to reduce infant mortality funded by MDH’s Eliminate Disparities in Health Initiative (EHDI)
  • Southwest MN Integrated Prenatal project
  • Doula programs
  • Tribal Health initiatives

Community Awareness
No research has documented community awareness of medical complications in pregnancy.

References

1. Minnesota Center for Health Statistics. 2003
2. Bennett T, Kotelchuck M, Cox CE, Tucker MJ, Nadeau DA. Pregnancy-associated hospitalizations in the United States in 1991 and 1992: a comprehensive view of maternal morbidity. Am J of Obstet and Gyn. 178:346-354. 1998.
3. Issues in Pregnancy Care. Women’s and Children’s Health Policy Center. Johns Hopkins University. 1999.
4. MMWR. Diabetes during pregnancy- US 1993-1995. 47(20):408-415. May 1998
5. Moore LL, Singer MR, Bradlee ML, Rothman KJ, Milunsky A. A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology 11(6):689-694. 2000.
6. DHS. Minnesota Pregnancy Assessment Form Report #2: Managed Care Organizations and Fee-for-Service Data for 1998-2001. September 2003.
7. CDC. 2002 Pregnancy Nutrition Surveillance- Minnesota. December 2003.
8. Rith-Najarian SJ, Ness FK, Faulhaber T, Gohdes DM. Screening and diagnosis for gestational diabetes mellitus among Chippewa women in northern Minnesota. Minnesota Medicine. 79:21-25. May 1996.
9. MDH.Diabetes Among American Indians in Minnesota. January 2001.
10. Scheffler RM, Feuchtbaum LB, Phibbs CS. Prevention: The cost-effectiveness of the California diabetes and pregnancy program. Am J of Public Health 82(2):168-175. 1992.
11. American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG). 2002. Guidelines for Perinatal Care. Washington, DC.
12. Institute for Clinical System Improvement. Routine Prenatal Care. 2003. www.ICSI.org [Attn: Non-MDH Link]
13. Moos MK et al. Preconception health promotion: a focus for women’s wellness. March of Dimes. Dec. 2002.