Troubling spike in severe pregnancy-related complications for all ages in Illinois

• Increase in annual rates of obesity were largest by far: 7.8% in 2016 to 22.3% in 2023
• Vaginal birth complications increased 22.4%; cesarean birth complications increased 48.9%
• Non-Hispanic Black mothers faced more than double the rate of severe complications compared to non-Hispanic white mothers
• Illinois data reflects national increases in obesity, hypertensive disorders of pregnancy and gestational diabetes in pregnant people of all ages

CHICAGO --- A new study from Northwestern Medicine reveals a troubling rise in severe maternal health issues and birth complications in Illinois from 2016 to 2023, closely linked to increases in chronic health conditions affecting pregnancy, such as high blood pressure, gestational diabetes, mental health disorders and especially obesity, which saw the largest increase in annual rates.

The study highlights significant racial and socioeconomic disparities, finding that non-Hispanic Black mothers faced more than double the rate of severe complications compared to non-Hispanic white mothers, and that living in high-poverty neighborhoods elevated maternal health risks across all racial groups.

“Despite significant recent statewide quality-improvement efforts, these birth outcomes are worsening for all ages, reflecting the worsening pre-pregnancy health of the reproductive-age population in Illinois,” said corresponding author Dr. Mugdha Mokashi, a resident physician in obstetrics and gynecology at the McGaw Medical Center at Northwestern.

The findings reflect national trends demonstrating the increasing prevalence of conditions such as obesity, hypertensive disorders of pregnancy and gestational diabetes among pregnant people of all ages, she added. The study provides the most updated data on maternal morbidity and delivery complications within the state of Illinois.

The findings were published Nov. 21 in the journal Obstetrics & Gynecology Open.

“Our findings underscore the role of social determinants of health — such as race and income — in driving disparities in maternal health, suggesting that efforts to reduce maternal morbidity need to address both racial inequalities and economic hardship,” said study co-author Dr. Lynn Yee, associate professor of obstetrics and pulmonology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine maternal fetal medicine physician.

Breaking down of the findings:

In the study cohort of 988,480 births at 127 Illinois hospitals between January 2016 to June 2023, the overall rate of severe maternal morbidity rose from 1.4% in 2016 to 2% in 2023. Vaginal birth complications increased 22.4%, and cesarean birth complications increased 48.9%.

Hypertensive disorders of pregnancy and anemia — both of which increased over the study period — were significant risk factors for severe maternal morbidity and birth complications. The largest increase by far was in annual rates of obesity from 2016 to the first six months of 2023 (7.8% to 22.3%). Additionally, there were increases in gestational diabetes (4.2% to 5.5%), depression (2.5% to 6.6%), anxiety (3.1% to 10.4%) and other chronic comorbidities (4.7% to 7.4%). Non-Hispanic Black patients had more than double the severe maternal morbidity rate (2.6%) compared to non-Hispanic white patients (1.1%).

Health counseling before pregnancy is important

Maternal health affects almost everyone, and those thinking about pregnancy should be sure to check in with their health care provider to screen for any chronic conditions they may have before getting pregnant, the study authors said.

“Pre-conception counseling is such an important way to make sure that all of your health conditions are optimized prior to pregnancy,” Mokashi said. “There are many important policy and public health initiatives in Illinois that people may be interested in learning more about.”

‘It’s not just because the people getting pregnant are older’

While not the original aim of the study, the scientists did additional analysis that found the increased prevalence of maternal health issues and birth complications is not simply because the people getting pregnant are older. The findings reflected an increase in hospital coding for hypertensive disorders of pregnancy, gestational diabetes, anemia, depression, serious mental illness and other chronic conditions, especially obesity, even among those giving birth who are younger than 30.

“In brief, even young pregnant patients have more medical conditions and complications in pregnancy,” Mokashi said.

What can be done?

Policies for poverty alleviation — such as the proposed refundable child tax credit in Illinois, House Bill 4917, if passed — have demonstrated improvement in maternal health, the study authors said.

Perinatal quality initiatives in California have reduced postpartum hemorrhage-related morbidity. Similarly, the Illinois Perinatal Quality Collaborative is working to reduce cesarean births and address racial disparities through Promoting Vaginal Birth and Birth Equity initiatives.

Increasing access to doula support and patient navigator programs could also be useful supports, Mokashi said. In 2024, the Illinois Department of Healthcare and Family Services adjusted reimbursement for doula services. At Northwestern, research on patient-navigator programs have shown promise in reducing care disparities for low-income minoritized patients postpartum. And at the federal level, passage of the 13 bills comprising the Black Maternal Health Momnibus Act re-introduced in 2023 would provide critical funding support to increase data collection and quality initiatives for prevention of maternal morbidity.