“There are a whole slew of social factors that impact health outcomes and that plays a role when we are talking about higher complications in pregnancy,” said Dr. Rose Molina, an OB-GYN at Beth Israel Deaconess Medical Center in Boston who has written about maternal mortality.
To identify women at risk for such complications, Providence has set up a tool in its electronic health record. Various questions about the mother's circumstances are documented and depending on the responses, physicians will be alerted when extra precaution should be taken.
While care practices before and during pregnancy are important, so is care afterward, ACOG's Hollier said. Women can die from pregnancy-related reasons up to about a year after labor.
To address this, the specialty society in May updated its guidelines for postpartum care. Instead of a one-time checkup six weeks after delivery, obstetricians are encouraged to contact mothers within the first three weeks postpartum and provide ongoing follow-up care as needed.
“What this does is it really emphasizes the need to ensure that the woman is getting the right healthcare for her specific situation,” Hollier said. The guidelines also help to ensure women on Medicaid because of pregnancy get the appropriate follow-up care before they lose access.
The ACOG is also working on guidelines to address women's long-term risk for heart disease after pregnancy. Hollier said more women are dying from cardiac issues, while deaths from hemorrhage and high blood pressure are falling. The ACOG expects to have the guidelines released by May 2019.
“Women who have pregnancy complications like pre-eclampsia or diabetes have an increased risk of developing heart disease later in life. We want to better identify these women and how best to take care of them,” Hollier said.