Nov. 17, 2022, 8:48 a.m. News Staff — Family physicians and members of the general public are invited to comment on the draft version of a systematic review from the Agency for Healthcare Research and Quality that examines the relationship between social and structural determinants of health and risk factors for maternal morbidity and mortality.
The draft report is available for review on the agency’s Effective Health Care Program website. Comments will be accepted until 11:59 p.m. ET on Dec. 4.
The draft comes amid growing concerns about U.S. women’s health in general and maternal health in particular and the role family physicians can play in providing care for women before, during and after childbirth.
According to the Commonwealth Fund, the United States has the highest rate of maternal deaths among high-income countries. U.S. women of reproductive age also have high rates of mental health needs and multiple chronic conditions and are significantly more likely to have difficulty paying medical bills and to skip or delay necessary care because of costs.
Moreover, CDC data show that pregnancy-related mortality in the United States more than doubled — from 7.2 to 17.3 maternal deaths per 100,000 live births — between 1987 and 2018, the latest year for which information was available.
The mortality rate was even higher among women in some racial and ethnic minority groups. Between 2016 and 2018, the pregnancy-related mortality ratio for non-Hispanic Black women was 41.4 maternal deaths per 100,000 live births; for non-Hispanic American Indian or Alaska Native women, it was 26.5 per 100,000 live births. In comparison, the ratio for non-Hispanic white women was 13.7 per 100,000 live births.
AHRQ developed the draft report in conjunction with “Identifying Risks and Interventions to Optimize Postpartum Health,” an upcoming NIH Pathways to Prevention workshop.
The draft includes 109 studies published through April 2022 that reported social and structural determinants of health associated with maternal health outcomes. Outcomes included not only maternal mortality and morbidity but also hypertensive disorders, gestational diabetes, cardiometabolic disorders, “weathering” (the physiological effect of premature aging caused by chronic stress), depression, other mental health or substance use disorders, and cost/health care use.
The researchers found that both the depth and quality of available research was limited, which made it difficult to draw conclusions about the connections between social/structural determinants of health and risk factors for maternal morbidity and mortality. Most of the studies, they noted, used correlational study designs rather than analytic approaches to determine the cause of a particular health outcome.
Given the lack of quality studies available for review, the investigators said that “considerable opportunities exist for future research to improve the outcomes measured and captured.” They called for the development of studies that
Individuals may submit comments through an online submission form. Users have the ability to comment on each section of the draft, as well as to provide general comments about the report’s results and conclusions. They may also submit supporting documents.
Individuals who have difficulty with the online submission form may email their comments to email@example.com.