We MUST Do Better on Maternal Health

The first time I saw a new mother die, I was early in my career. A healthy, young woman had a complication during labor and needed a C-section. While the care team delivered a healthy baby, the mother never regained consciousness and eventually passed away. I remember seeing her husband late that night in the hospital, holding his new baby. It was supposed to be the happiest moment of his life, but instead he looked completely lost.

That moment had a profound effect on me and is one of the reasons I’ve committed my career—and now my ACOG presidency—to reducing preventable maternal mortality. As I said last week at the 2018 ACOG Annual Meeting in Austin, Texas, where I was sworn in as the 69th president of ACOG, “To achieve our full potential not just as women, but as a country, and as a global community, the health of women MUST be a priority.”

As ob-gyns, we dedicate our lives to advancing women’s health, and there is no contradiction more stunning than the rise of maternal mortality and morbidity in the United States. While other countries have been able to reduce maternal deaths over the last 20 years, the U.S. continues to see rates grow. Worse yet, African American women are two to four times as likely to die from pregnancies than Caucasian women.

During my year as president, ACOG will continue its good work surrounding the issue of maternal mortality through three initiatives:

  1. Advocacy on the state and federal level to establish maternal mortality reviews. These state-based reviews offer a valuable opportunity to understand maternal death through a detailed review of medical records and autopsy reports. By finding causes of and contributing factors to maternal death, we can identify opportunities to prevent them.
  2.  A stronger culture of patient safety in hospitals. ACOG helped found the Alliance on Innovation on Maternal Health (AIM), a national maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Together with 19 partner women’s health care organizations, ACOG has worked with hospitals and health systems to implement patient safety bundles across the country. Today, 23 states are part of AIM, and it’s our goal to sign on all 50 states.
  3. A taskforce devoted to heart disease in pregnancy. Cardiovascular disease is the number one cause of death in women in the U.S. (400,000 deaths annually), and cardiovascular events and cardiomyopathy are the leading causes of maternal mortality, accounting for nearly 25 percent of deaths. This multidisciplinary taskforce will concentrate on creating evidence-based, best practice guidelines addressing screening for, diagnosis, and management of cardiovascular disease in women, before, during and after pregnancy. It will also address the pregnancy-related contributions to lifelong cardiovascular risk by evaluating the evidence, making recommendations, and prioritizing research that will drive better care.

While I’m excited to have this opportunity to focus on safe motherhood, one of the most enjoyable aspects of this position is to meet you, my fellow members. I look forward to working with you, and our new class of Fellows who took the oath last week, to provide the best clinical care to women of this country. Please connect with me on Twitter @TXmommydoc, and follow @acognews to keep up with the latest news in our profession.

“AIM”ing to Reduce U.S. Maternal Mortality

During the past several weeks, you would be hard-pressed not to find an article about the dismal maternal mortality rates in this country. In fact, it was a study published in our very own Green Journal that sparked the latest national conversation (with Texas at the epicenter) about why the most modern, industrialized country in the world is failing so miserably at reducing the numbers of deaths associated with pregnancy and childbirth. However, the truth of the matter is, we already know why.

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Setting the Record Straight on Drinking During Pregnancy

When confronted with so many different types of infections and viruses that can threaten the health of an unborn baby, it’s unfortunate that drinking during pregnancy is still the leading cause of birth defects in this country and abroad. Without knowledge of the devastating effects, it’s easy to have a casual attitude toward drinking but when a fetus is exposed to any amount of alcohol it can lead to a number of permanent and debilitating conditions. These are known as fetal alcohol spectrum disorders (FASD) and can include anything from severe brain damage and growth deficits to lifelong learning and behavioral problems in children. September is designated as FASD Awareness Month but my hope is that at some point in the near future there is no longer a need to observe it because the fact is—FASD is 100 percent preventable.

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Zika Provider Action Week

The White House has declared this week Zika Provider Action Week. This call to action could not come at a better time. The Zika virus has occupied our profession and our patients nearly non-stop since news of it broke last fall. There is no doubt that Zika presents a very real concern to patients and challenge to health care providers. With the discovery of virus transmission by mosquitoes here in the United States, many of us are faced with the even more real possibility of treating patients with potential or confirmed exposure.

As ob-gyns, we are on the front lines of patients’ concerns about Zika. As each new finding is played out in the news, our patients call or come in looking for answers to help their understanding of the risk, and more often than not, assuage their fears. Unfortunately, in the instance of Zika, we too are often scrambling for knowledge, seeking elusive answers from research institutions and government agencies. The Centers for Disease Control and Prevention (CDC) has done an admirable job working quickly and efficiently to assess, address, and educate the American public about the Zika outbreak.

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Call to Action for an International Day for Maternal Health and Rights

Vineeta Gupta MD, JD, LL.M Technical Director, Global Women's Health American College of Obstetricians and Gynecologists

Vineeta Gupta MD, JD, LL.M
Technical Director, Global Women’s Health
American College of Obstetricians and Gynecologists

A woman dies from pregnancy or childbirth every two minutes. Almost all of these deaths (99%) are in developing countries. The most heartbreaking part is that the vast majority of these deaths are preventable.

As the nation’s leading group of physicians providing health care for women, ACOG strongly advocates for quality health care for women – everywhere.

That’s why, in an effort to demonstrate the urgency of global action to protect maternal health and rights, ACOG recognizes today as the International Day for Maternal Health and Rights.

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Enjoying Summer While Fighting Obesity

Ah, summertime is here again and you know what that means. Warmer weather and longer days: the perfect time to remind our patients (and ourselves) to enjoy the outdoors and get active in the fresh air. Walking, riding bikes, and swimming are all ways to work out while making the most out of the season.

This is not about getting back into a swim suit, but about fighting obesity. Just last month in my inaugural address, I challenged ACOG members to join me in the fight against obesity. Why? Because, in our country alone obesity claims 300,000 lives a year. The health hazards of being obese are quite well known: diabetes, heart disease, high blood pressure and stroke. Obese women are also at a higher risk for numerous types of cancer, including esophageal, pancreatic, colorectal, postmenopausal breast, endometrial, ovarian and renal.

Approximately 36% of adult women in the United States are affected by obesity, and that number has been on the rise. Therefore, physicians have been faced with the challenges inherent in caring for these patients. As ob-gyns, we are, for many patients, the only physician a woman sees on a regular basis. Moreover, we have highly trusted relationships with our patients due to the sensitive nature of our specialty. Ob-gyns are in an ideal position to help educate women and provide counsel on the importance of a healthy lifestyle and fighting obesity.

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A Healthy Weight for Pregnancy

It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.

A Turn of the Stomach

We heard exciting news out of the UK this week: Prince William and his wife Kate Middleton are expecting their first child. But the excitement was tempered with concern when reports of the Middleton’s pregnancy-related hospitalization surfaced. She’s reportedly suffering from hyperemesis gravidarum, a severe form of morning sickness that affects up to 2% of pregnant women.

“Morning sickness” refers to the nausea and vomiting of pregnancy. The phrase is misleading because it’s not confined to the morning—as many pregnant women can attest—but the condition is common in early pregnancy, affecting roughly 70%–85% of pregnant women. Symptoms usually strike without warning and can range from mild, occasional nausea, to severe, continuous nausea with bouts of vomiting. Some women may become nauseated by the smell of certain foods or get sick after eating.

Morning sickness typically begins within the first nine weeks of pregnancy, with symptoms often improving by week 14. What causes morning sickness is unknown, but the surge of pregnancy hormones is a likely factor. Though morning sickness can weaken a pregnant woman’s quality of life, most mild to moderate cases will not harm you or your baby’s health.

More serious problems can arise in women who can’t keep any food or liquids down and begin to lose weight, as is the case with hyperemesis gravidarum. Women who cannot tolerate liquids without vomiting and show signs of dehydration may need to be given intravenous fluids and nutrients in the hospital. The risk of developing hyperemesis gravidarum may be higher if you are carrying multiple fetuses, have a mother or sister who had the condition, are carrying a female fetus, have a history of hyperemesis gravidarum in a previous pregnancy, or have a history of motion sickness or migraines.

Many women assume that morning sickness is a pregnancy rite of passage and avoid telling their doctor about their symptoms or downplay how bad they feel. This is not the time to grin and bear it. Symptoms can get worse over time and it’s often harder to treat morning sickness once it becomes severe. If you can’t keep any food or fluid down for more than a day or are becoming dehydrated, contact your ob-gyn right away.

If you have mild morning sickness, these tips may help:

  • Try vitamin B6 supplements
  • Eat crackers before getting out of bed
  • Drink beverages made from real ginger such as tea or ginger ale
  • Consume smaller nutritious, high-protein meals and snacks throughout the day
  • Get enough rest
  • Avoid foods and smells that make you feel sick.

For more severe cases, anti-nausea medications or a short hospital stay may be necessary.

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Placenta Problems during Pregnancy

How much do you know about the placenta? If you’re like most people, probably not much. But for the millions of women in the US who become pregnant each year, the placenta becomes a very interesting organ.

The placenta forms during pregnancy and serves as the life support system for a growing baby. It supplies the baby with oxygen, nutrients, and hormones, removes waste products through the umbilical cord, and is vital for a healthy pregnancy and delivery. In some pregnancies, problems with the placenta occur that can endanger mother and baby.

You may have recently heard about placenta previa, a condition that threatened actress Tori Spelling’s fourth pregnancy. Roughly 1 in 200 pregnant women will experience this potentially serious complication. Blood vessels attach the placenta to the uterus. In women with placenta previa, the placenta lies low in the uterus and may partially or completely cover the cervix, blocking the baby’s exit from the uterus. Placenta previa can also cause excessive bleeding in the mother when the cervix begins to thin and open in preparation for delivery. The risk of developing placenta previa is higher in women who’ve had more than one child, a cesarean delivery, surgery on the uterus, or who are carrying twins or triplets.

Roughly 1% of women will experience placental abruption—the detachment of the placenta from the uterus before or during birth. Placental abruption deprives the baby of oxygen and can cause the mother to lose large amounts of blood. Symptoms may include vaginal bleeding and severe abdominal or back pain. Placental abruption usually occurs in the last 12 weeks of pregnancy and is more common among women who have high blood pressure, smoke, or use cocaine or amphetamines during pregnancy. Women who’ve had a previous placental abruption, have had children, are older than 35, or have sickle cell disease are at higher risk.

Placenta accreta occurs when the blood vessels that attach the placenta grow too far into the uterine wall. The condition can cause bleeding during the third trimester of pregnancy and severe, life-threatening blood loss during delivery. Previous cesarean delivery is the main risk factor for placenta accreta, and the risk increases with each cesarean a woman has had.

If you experience bleeding during pregnancy, talk to your doctor right away. It may be related to a placental problem that requires prompt treatment. Learn more about placenta problems during pregnancy.

Fighting Preeclampsia in May and Beyond

This is my last blog post as ACOG president (I continue as immediate past president for another year), so I’d like to finish where it all began, with my Issue of the Year: preeclampsia. It’s a condition that affects up to 7% of pregnant women, and in my opinion, it’s the most important medical complication of pregnancy. It’s potentially life-threatening to mother and baby during pregnancy and can signal health problems for the mother later in life. Unfortunately, this serious and common condition is understudied and largely misunderstood.

As part of my President’s Program on Monday, May 7, at The College’s Annual Clinical Meeting, I invited three of my esteemed colleagues at the forefront of preeclampsia research to share what we know, what’s new, and the advances that may be coming soon in preventing and treating preeclampsia. This session will help educate ob-gyns about the condition. It’s imperative that physicians appreciate a patient’s experience of preeclampsia. It’s also extremely important to raise awareness of the signs and symptoms of preeclampsia among women.

High blood pressure and protein in the urine can both signal preeclampsia. Because these changes are hard—if not impossible—for women to spot, blood pressure and urine tests are routinely checked at each prenatal visit. Other symptoms may arise, especially in the last three months of pregnancy, including sudden weight gain, headaches, swelling of the face or hands, blurred or altered vision, chest pain or shortness of breath, pain in the upper right abdomen area, and nausea and vomiting. These symptoms may seem normal, but because preeclampsia can worsen quickly, it’s important that pregnant women alert their doctor immediately if they occur.

Preeclampsia Awareness Month (PAM) in May is an excellent time to educate women and spread the word about this condition. The Preeclampsia Foundation’s website has a page devoted to the signs and symptoms of preeclampsia and what women can do to monitor themselves for preeclampsia-related changes. The foundation also has great news and information about risk factors, resources, and local PAM events. The more we know, the safer we can make pregnancy for women and their families.