Severe pregnancy complications rising in Illinois, affecting Black mothers the most

Chronic health problems are fueling a troubling spike in severe pregnancy complications in Illinois.

A new study from Northwestern Medicine found more patients are developing high blood pressure, gestational diabetes, mental health disorders and obesity while pregnant. The trend is even worse for Black women and people living in poor neighborhoods.

The rise in Illinois reflects national increases in obesity, hypertension and gestational diabetes in pregnant people of all ages.

"Racial disparities in maternal health are not new," said Dr. Mugdha Mokashi, an obstetrics and gynecology resident at Northwestern Medicine and one of the researchers on the study.

"So the fact that nothing has improved, even though we have known about these issues for a while, is really, really troubling."

Black women faced more than double the rate of severe complications compared with their white counterparts, according to the study's findings.

Northwestern researchers looked at nearly 1 million births at Illinois hospitals between January 2016 and June 2023. During that time, the overall rate of severe maternal morbidity rose from 1.4% to 2%. Severe maternal morbidity describes the life-threatening complications that can occur during pregnancy, labor and immediately after delivery.

Complications during vaginal births increased 22% and cesarean birth complications increased nearly 50%.

Those chronic conditions can put the pregnant person and their baby at risk during pregnancy and birth. They're all tied together, Mokashi said. Mental health issues like chronic stress can increase a person's blood pressure. Higher blood pressure increases the risk of diabetes during pregnancy.

And although obesity isn't a perfect predictor for poor health — people can be healthy at any weight, Mokashi said — the condition is linked to high blood pressure and diabetes.

"These are life-limiting, long-term impacts," Mokashi said.

Researchers said a solution to this spike is stronger policies that help lift people from poverty and improve access to health care.

“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 Dr. Lynn Yee, an author on the study and a maternal fetal medicine physician at Northwestern.

Though more people are delaying pregnancy to later in their child-bearing years, the rise in severe complications isn't simply age-related, Mokashi said. Pregnant people ages 20 to 29 are also getting sick with these chronic conditions.

Part of the problem is not enough pregnant people in Illinois can access prenatal care, Mokashi said.

"There's a huge divide between what is needed and what people are able to access," she said. "We know in Illinois many people aren't getting prenatal care at all."

And even fewer people interested in having a baby are undergoing pre-conception counseling, which is an opportunity for patients to better manage any existing chronic health problems before getting pregnant.

"Pre-conception counseling helps people to optimize their health so that their pregnancy can be the safest possible thing for them and their families," Mokashi said. "But these enormous disparities along racial lines go beyond someone's first prenatal visit and are significantly impacted by structural racism and access to health care."

These findings came as no surprise to Kayla Kinsler, a doula and the intake coordinator for Chicago Birthworks Collective, an organization that provides doula services to Black families in Chicago.

Poverty also makes it challenging for pregnant people to not only access quality health care but to manage chronic diseases like diabetes and high blood pressure. Eating healthy and exercising can be impossible when living in a food desert with little green space.

"Addressing social determinants of health would also improve maternal health care," Kinsler said.

The study identified doula support as one step toward improving care for pregnant people. Doulas are guides for expectant mothers during pregnancy and through childbirth. They help develop birth plans, answer questions and provide emotional and physical support.

"Doulas are definitely one step toward bettering the care for pregnant women," Kinsler said. "We're there to hold their hand. We're another person in the room advocating for them, talking things through with them, making sure they're an active participant in their care."