Minnesota Title V MCH Needs Assessment Fact Sheets
Pregnant Women, Mothers and Infants
Medical Complications During Pregnancy
Summer 2004
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 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.
