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Bexar County to look at increase in women dying from pregnancy-related causes

San Antonio Express NewsJuly 31, 2017Articles

San Antonio health officials have launched a task force that mirrors a state-level initiative to figure out why there’s been a decade-long increase in the number of mothers dying within a year after childbirth.

In Bexar County, the rate of mothers dying from pregnancy-related causes climbed from 6.8 deaths per 100,000 live births in 2005 to 41 in 2016, the second-highest year in the past decade, according to data from the San Antonio Metropolitan Health Department. In 2014, the actual number in Bexar County was 11, according to the Texas Department of State Health Services.

The Bexar County Maternal Mortality and Morbidity Review task force, which had its first meeting last week, wants to figure out why and is not waiting for the state, which has had a task force on the problem since 2013.

“I’m exceedingly frustrated by the lack of awareness and action being taken to address this problem,” said Dr. Ruth Berggren, a member of the county task force. “I think it’s high time we stopped waiting around for higher levels of government and started taking action on local levels, because we can do certain things that would have an impact and make a difference.

“Now we’re in a situation where Texas was on top of it and looking into (the) problem, but not adequately and not fast enough,” she added.

Bexar County officials think they are in a better position to collect data from local hospitals and communicate with local providers to lower mortality rates. This community-based approach “makes the most sense,” Berggren said.

“There are enormous disparities; there are counties where we clearly have higher levels and there are other counties that are doing much better,” Berggren said. “We would benefit as a nation by scrutinizing what the characteristics are of the counties that are doing well and how they compare to those that are doing poorly.”

Kori Eberle, healthy program manager at Metro Health, said the task force, which plans to meet quarterly, won’t begin looking at county data until next year after members finish training.

The rise in maternal mortality cases isn’t just a Bexar County problem.

The county’s effort comes as Texas legislators consider a bill by state Rep. Shawn Thierry, D-Houston, in the special session that would give the statewide task force, which is set to expire in 2019, until 2023 to further study the crisis.

Last year, the task force reported that 189 Texas mothers died within a year of giving birth in 2011-2012. Around the same time, a national medical journal released a study showing the rate of deaths had nearly doubled from 2010-2014, making the state the worst in the country and even the developed world. Most of the mothers died from heart disease, drug overdose, hypertension or hemorrhaging.

“All these issues come together — you have obesity, then you have hypertension, you have diabetes,” said Dr. Margaret Kelley, a San Antonio OB-GYN and chair of the county task force. “If you add on top of that pregnancy, it can be a very volatile mixture.”

Kelley said the task force will look at persistent health issues in the county that may be at fault. These “high-risk” factors include obesity and diabetes, which are major problems that are known to lead to heart disease, the leading cause of death in Texas mothers at 21 percent, according to the state task force report.

The report made several recommendations on how the state could examine and address the problem. These included increasing access to care up until a year after birth; increasing screening for mental and behavioral health issues (especially postpartum depression); and improving the quality of death certificate data.

Kelley said the state task force was right to look at cases where the mother died up until a year after childbirth, rather than within the first 42 days, like some other studies.

“By looking a year out, you’re able to pick up on greater trends, such as the mental health aspect of these cases,” Kelley said. “The value in looking at these issues (within a year after birth) is to be in a better position to lobby for a system where patients can have care in between their pregnancies.”

In its 2016 report, the task force found that African-American mothers were far more at risk of pregnancy-related death than any other demographic group. While they accounted for 11 percent of all live births, African-American mothers disproportionately made up 29 percent of all deaths that year. On the other hand, white mothers had 35 percent of all live births but 38 percent of deaths.

“We have an initial snapshot for what the global problems are for maternal mortality in Texas, but we haven’t drilled down into those high-risk populations to figure out if there are opportunities for intervention,” said Dr. Patrick Ramsey, a San Antonio physician and a member of the state task force. “By continuing the task force’s work, we’d be able to get a better, more robust understanding of those issues.”

Thierry’s House Bill 11 takes the racial disparities into account, expanding the duties of the state task force to collect data and directing members to analyze what programs have worked in other states, like California and North Carolina, where the gap in maternal mortality rates among racial and ethnic groups has shrunk in the past few years.

On Wednesday, several bills related to the state task force, including HB 11, were unanimously passed out of the House Public Health Committee. The companion legislation, Senate Bill 17 from state Sen. Lois Kolkhorst, R-Brenham, unanimously passed the Senate and now heads to the House.

HB 11 is among Gov. Greg Abbott’s priorities for the special legislative session and is expected to pass. But either way, Kelley said the county task force plans to address the racial disparities among women who have died locally of pregnancy-related causes.

“In San Antonio, the black population has never been over 7 percent, so you might not see the trends in Bexar County that you see statewide,” Kelley said. “But you never know, that’s why you need to pull the data to see if that racial disparity is present or not.”

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