This was originally published in October 2022 Breakthroughs.
A recent report by the CDC found that four out of five deaths during pregnancy, delivery or even up to a year postpartum could have been prevented. The U.S. has the highest maternal death rate of any high-income country, and research is needed to pinpoint why as well as determine how to prevent maternal deaths.
Additionally, maternal mortality will only increase in the wake of the Supreme Court’s overturning of Roe v. Wade in June, according to Melissa Simon, MD, MPH, vice chair for research in the Department of Obstetrics and Gynecology.
“Overturning this law will increase the already rising U.S. maternal mortality rates. This Supreme Court decision is dangerous for women,” Simon said.
The Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization has created confusion for many women seeking medical care when pregnant. Nevertheless, Feinberg investigators continue to pursue research that identifies important factors that impact maternal health.
Discovering Patterns and Risk Factors
Through research into women’s heart health and experience during pregnancy, Northwestern scientists have learned the ways women’s health is impacted by social determinants, including what part of the country they live in.
Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME, assistant professor of Medicine in the Division of Cardiology, was the senior author of a study published in Circulation that found more than half of young women between the ages of 20 and 44 who gave birth in 2019 had poor heart health before becoming pregnant.
“We tend to think about the baby’s health once we become pregnant, but what so many women don’t realize is the very first thing they can do to protect their babies (and themselves) is to get their heart in shape before they even conceive,” Khan said.
In the study, the investigators compared data by geographical region. Even as good heart health was declining overall across the country, there were differences based on geography. The percentage of women with good heart health was lower in South (38.1 percent) and Midwest (38.8 percent) states, compared with states in the West (42.2 percent) and Northeast (43.6 percent).
“The geographic patterns observed here are, unfortunately, very similar to what we see for heart disease and stroke in both women and men,” Khan said. “They indicate how factors such as social determinants of health play a critical role in heart health as well as maternal health.”
Listen to an episode of the Breakthroughs Podcast on this research:
Another study published in JAMA led by Khan found that over the past decade the rate of gestational diabetes has risen 30 percent in young U.S. women. For U.S. women who identify as Asian-Indian, the rate has more than doubled when compared with non-Hispanic white women.
“The consistent and continued increase over the last decade could have significant impact on not just pregnancy health and outcomes for the mom and baby, but also long-term health for both,” Khan said. “Gestational diabetes is linked to a higher risk of cardiovascular disease for the mom and child.”
The study also reported that chronic diabetes present prior to pregnancy (Type 1 or 2) rose more than 20 percent since 2011 and was nearly twice as high in non-Hispanic Black and Puerto Rican individuals.
“The pandemic could push these gestational diabetes numbers even higher due to lifestyle changes in exercise, eating and increased stress,” Khan said.
Knowing these staggering statistics is important to intervening. Some of the interventions Northwestern is involved with include using artificial intelligence (AI) to develop low-cost ultrasound and applying patient-centered interventions that empower pregnant people.
In collaboration with Google, Mozziyar Etemadi, MD, PhD, assistant professor of Anesthesiology, is leading a project to bring fetal ultrasound to developing countries by combining AI, low-cost hand-held ultrasound devices and smartphones.
The project will involve developing algorithms that enable AI to read ultrasound images from these devices taken by trained community health workers and even pregnant people at home, with the aim of assessing the wellness of both the birthing parent and baby.
The AI will receive professional and amateur images across the many conditions that physicians typically want to monitor, such as the age of the fetus and whether it has a heart defect. By having these side-by-side image captures, the AI can adapt to interpret the amateur image capture and learn to interpret the images more accurately.
“The real power of this AI tool will be to allow for earlier triaging of care, so a lightly trained community health provider can conduct scans of birthing parents. The patients don’t have to go to the city to get it. The AI will help inform what to do next – if the patient is OK or they need to go to a higher level of care. We really believe this will save the lives of a lot of birthing parents and babies,” Etemadi said.
Another Northwestern study published in JAMA found that women with early, nonviable pregnancies who were given an active management strategy, which was defined as either with methotrexate alone or uterine evacuation with methotrexate as needed, had more successful pregnancy resolutions than those given an expectant management strategy. Emily Jungheim, MD, the Edmond Confino, MD, Professor of Obstetrics and Gynecology, was a co-author of the clinical trial.
“When it comes to pregnancy and women’s health, we really are trying to get to a place where we can be more patient centered, and I think this particular study is in that spirit,” said Jungheim, who is also chief of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
“It provides us more information to help educate our patients when they’re faced with these tough decisions of what makes the most sense for them.”
Further research is needed to address this complex issue of maternal mortality and morbidity. Simon is leading this work with her NIH-funded studies: Enhancing Perinatal Care Support to Improve Maternal Mortality Disparities and The OPTIMIZE Study: Optimizing Patient Navigation for Perinatal Care.
Marla Paul, Kristin Samuelson and Melissa Rohman contributed to this story.