U.S. Moms-to-Be Are Much Less Healthy Now
In the past 30 years, U.S. women have been in progressively worse physical shape as they become pregnant, a new study finds.
A combination of obesity, high blood pressure, diabetes and having children later in life have led to potentially more complications, and even infant and maternal death, researchers say.
Obesity is a major driver of these complications, said lead researcher Dr. Eran Bornstein. He's vice chair of the department of obstetrics and gynecology at Lenox Hill Hospital in New York City.
"They're also going to have more hypertensive disorder [high blood pressure] because older women are at a higher risk for all of these complications," he said. "Basically, we showed that over the last three decades, women's health in the United States has worsened."
For the study, Bornstein's team used data from the U.S. Centers for Disease Control and Prevention to calculate risk factors and trends in pregnancies from 1989 to 2018.
During that period, the prevalence of high blood pressure disorders rose 149%, the investigators found.
Specifically, chronic hypertension increased 182%, diabetes increased 261% and having babies at an older age rose 194%. Also, the number of twin and triplet births increased 33%.
The increase in chronic hypertension was mostly seen in the past 20 years. High blood pressure tied directly to pregnancy and having more than one baby was seen largely in the last 10 years, the findings showed.
The rates of all these conditions were highest among women who had children later in life, the study authors noted.
"Hypertensive disorder is associated with significant morbidity to the mother and significant complications for the baby," Bornstein said. "Hypertensive disorders of pregnancy are one of the three major risks for maternal mortality."
The advice to women is twofold, he said. "First of all, even before pregnancy, young women should concentrate on improving their health and their metabolic status. That means that they watch their weight, diet, exercise -- just the basics in good health care," Bornstein said.
Second, women should be aware of the potential consequences of delaying childbearing, "and try to complete childbearing at a younger age," he said.
It's difficult to tell women they need to complete childbearing by a certain age, but childbearing at 40 is associated with major complications, Bornstein said.
Dr. Rahul Gupta is chief medical and health officer at the March of Dimes. He said, "More and more women are making sure that they are economically secure before they're planning to have a family, and that does increase the age at which they're having first pregnancy."
But age increases the risk of conditions like diabetes, high blood pressure, preeclampsia, bleeding during delivery, cesarean delivery, preterm birth and stillbirth, Gupta explained.
Having a healthy pregnancy starts before getting pregnant, he stressed.
"Make sure your body is prepared to become pregnant -- that includes getting to the right weight and making sure that your diabetes and high blood pressure are controlled before you get pregnant," Gupta said.
If you keep your blood sugar and blood pressure at normal levels, he noted, the outcomes will be as normal as possible for most women.
"That's really the key here. It's not the diabetes or the hypertension, it is the lack of ability to maintain your blood sugar, your body weight and your blood pressure at normal levels that create the conditions for poor outcomes for both you and your baby. So, keep these things under control," Gupta advised.
The report was published online recently in the journal E Clinical Medicine.
For more on a healthy pregnancy, head to the March of Dimes.
SOURCES: Eran Bornstein, MD, vice chair, department of obstetrics and gynecology, Lenox Hill Hospital, New York City; Rahul Gupta, MD, MPH, chief medical and health officer, March of Dimes; E Clinical Medicine, Nov. 18, 2020, online
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