BATON ROUGE, LA—A new study from the Blue Cross Blue Shield Association (BCBSA) shows that both pregnancy and childbirth complications increased 16.4% and 14.2%, respectively, between 2014 and 2018, with women who experience pregnancy complications becoming twice as likely to have childbirth complications as well.
The findings come from a new BCBSA report, “Trends in Pregnancy and Childbirth Complications in the U.S.,” part of the Blue Cross Blue Shield The Health of America Report® series. The report examined 1.8 million pregnancies between 2014 and 2018 among commercially insured women ages 18-44.
Millennial women make up 85% of all pregnancies in the United States. According to The Health of Millennials report, this age group has experienced a double-digit increase in eight of the 10 top health conditions—such as major depression, hypertension and type II diabetes—that may lead to higher risks of pregnancy and childbirth complications.
Since 2014, pregnant women aged 18-44 have seen a:
The report found that while the national rate of pregnancy complications in the study cohort was 196 out of 1,000 pregnancies, the Louisiana rate was much higher at 222.1.
Tonya Evans, registered nurse and manager of Population Health at Blue Cross and Blue Shield of Louisiana, says there are a number of reasons that could add up to higher pregnancy complications in Louisiana. One, she says, is that many women are getting pregnant later in life, which can cause fertility issues and other complications.
However, Evans points to the overall poor health status of Louisianians as the major culprit. The two pregnancy complications called out in the report—preeclampsia and gestational diabetes—can be linked to some of the conditions where Louisiana ranks worst, including high blood pressure, obesity and type II diabetes.
“It’s our way of life in Louisiana. It comes with being from Louisiana; we eat what we love and not always what’s good for us,” Evans says.
Several of the factors mentioned above likely contributed to the “F” grade the March of Dimes gave Louisiana in its 2020 Report Card. In addition to the overall “F,” the Report Card mentions that the preterm birth rate worsened from last year in a number of parishes, including East Baton Rouge, Jefferson and Lafayette.
The Blue Cross maternal health report discussed childbirth complications as well as those in pregnancy. The national rate of childbirth complications was 16.9 out of 1,000 pregnancies.
Evans says she believes Louisiana’s lower rate of childbirth complications, which include eclampsia, sepsis, cardiomyopathy, transfusion, embolism and respiratory distress, has to do mostly with the way labor and delivery claims are handled. “For pregnancy and delivery, the bill doesn’t come in until delivery; the hospital gets paid one lump sum that includes the delivery and all the prenatal care,” Evans says. “You only find out about pregnancy complications if they get referred out to a fetal medicine specialist,” she adds—but, in those cases, the claims are sent separately. These issues affect a report like this one that is based on commercially insured pregnant women.
After childbirth, American mothers saw a nearly 30% increase in postpartum depression diagnoses during the study period, with the diagnoses being most prevalent in women aged 18-24. The national rate for postpartum depression was 94.6, while Louisiana moms suffered slightly less at 70.4.
Pregnancy and childbirth support
To help expecting and current mothers access quality and affordable care, Blue Cross and Blue Shield of Louisiana continues to support programs and community-focused initiatives that help ensure the better health of America. A prime example is Healthy Blue Beginnings, the company’s care management program for high-risk pregnancies. This program offers pregnant women personalized information and confidential support from experienced nurses throughout their pregnancy.
“Part of the program is addressing postpartum depression, encouraging breastfeeding and making sure they get their six-week follow-up as well,” says Evans. Expecting mothers with concerns should talk to their doctors, who can refer them to Healthy Blue Beginnings if necessary. They can also call Blue Cross at 1-800-363-9159 and press 1 to speak with a nurse.
In addition to referrals from individual physicians, Blue Cross gets referrals to Healthy Blue Beginnings from its relationship with Louisiana Women’s Healthcare Associates (LWHA), the largest OB/GYN physician group in the state of Louisiana. Obstetricians at LWHA refer patients to Healthy Blue Beginnings if they have one or more of a list of conditions that includes diabetes, hypertension, obesity, a history of smoking, drugs or alcohol abuse, a history of preterm labor and more.
In the 2020s, data is now an important healthcare partner, and data plays a part with high-risk pregnancy referrals, too. Recently, Blue Cross began receiving Admit, Discharge, Transfer (ADT) data from any healthcare provider that uses an electronic medical records system and has a capability to feed the insurer their data. “With that came inpatient admits and ER visits, which help identify conditions that might affect a pregnancy,” Evans says.
Another pregnancy support program is a unique texting service called text4baby. Whether or not a woman joins Healthy Blue Beginnings, Blue Cross encourages her to join text4baby. Moms get free text messages with health and safety tips for their pregnancy and baby’s first year. The messages are tailored based on due date or baby’s birth date. Just text the word BABY (BEBE for Spanish tips) to 511411 on your cellphone. Participants can cancel the messages at any time. For more information, go to www.text4baby.org.
Blue Cross’ care management program Stronger Than can connect women to these programs as well as to a wide range of free or low-cost community services. One of these is Coffective, a coalition of community resources to support women before, during and after pregnancy. Find more at supportservices.bcbsla.com.
Blue Cross employees and the Blue Cross Foundation also support the health of babies and young children in a number of ways. The Foundation’s focus is on Louisiana children’s health and wellbeing, and many of its grants are awarded accordingly. One the Foundation’s most successful grantees, Fit NOLA, has recently expanded a program that lets doctors give “fruit and vegetable prescriptions” to pregnant women, people with diabetes and others, redeemable for free at local farmers’ markets. Blue Cross and its employees also donate their time and money to organizations like March of Dimes, which works to prevent birth defects.
The impact of COVID-19
The COVID-19 pandemic has had a direct impact on pregnant women, with one in four women skipping a prenatal visit and 53% reporting that they could not have a loved one in the delivery room with them; 15% delivered their baby at home. The increase in virtual care options also led to 48% of pregnant women shifting their prenatal appointments to virtual visits.
“Protecting the health and wellbeing of expecting and current mothers remains of paramount importance to the generational health of America moving forward, especially during these uncertain times,” said Dr. Vincent Nelson, vice president of medical affairs for BCBSA. “Whether it is through expanded virtual services or new resources to see a doctor in-person, BCBS companies are committed to helping mothers get the care they need, no matter the setting or circumstance.”
High-quality maternity care
For expecting mothers seeking information on the quality of care, Blue Distinction Centers (BDC) and Blue Distinction Centers+ (BDC+) for Maternity Care are healthcare facilities available across the country that meet quality selection criteria and in the case of BDC+, cost of care criteria as well. These Centers demonstrate better overall patient satisfaction and a lower percentage of early elective deliveries. In 2018, BDC/BDC+ facilities across the country cared for more than 40% of Blue Cross and Blue Shield commercially insured women giving birth. Several facilities across Louisiana have been designated as Blue Distinction Centers for Maternity Care.
This is the 31st study of the Blue Cross Blue Shield The Health of America Report® series, which uses an integrated dataset combining the pregnancy episodes data curated from BCBS Axis Data and the BCBS Health Index. In April 2020, BCBSA also surveyed >1,000 of commercially insured women 18-44 who were pregnant or delivered in March or April to understand the impact COVID-19 has had on their mental health, prenatal care, postnatal care and delivery plans.
For more information, visit The Health of America.
About Blue Cross and Blue Shield of Louisiana
Blue Cross and Blue Shield of Louisiana is committed to our mission to improve the health and lives of Louisianians. Founded in New Orleans in 1934, we are a tax-paying nonprofit health insurer with offices in every major region to serve our customers. We were recognized in 2019 and 2020 as an honoree of The Civic 50, named by Points of Light as one of the 50 most community-minded companies in the United States.
Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association. We are a private mutual company, owned by our policyholders, with an independent Louisiana Board of Directors and no shareholders. We invite all Louisianians to visit our website at www.bcbsla.com or talk to us on social media.