Issue link: https://tmcpulse.uberflip.com/i/834093
t m c » p u l s e | j u n e 2 0 1 7 35 According to Hollier, the task force found that the rate of complications increased across all racial and ethnic groups in Texas between 2005 and 2014. "There are a lot of physiologic changes that occur with pregnancy, so women who may have more pre- existing disease may be at higher risk," Hollier explained. "We do know that when we looked at the numbers, we found that high blood pressure, diabetes, obesity, cesarean delivery and late prenatal care were all seen more commonly in those women who died compared to those who did not." Another observation: it's difficult to measure how much the surge in prescription opioids and drug over- doses dovetails with maternal mortality in Texas, yet the task force did identify many missed opportunities for screen- ing and referral to treatment during prenatal care, delivery hospitalization and postpartum care for mental health conditions. "There's no doubt that mental health and access to care for underserved women are major drivers," Blackwell said, "but are they 'pregnancy issues,' or is that more of a societal issue?" This question speaks to one of the most complicated components in the analysis of the maternal mortal- ity numbers: the distinction between pregnancy-related deaths and pregnancy-associated deaths. "Pregnancy-related deaths are due to any cause related to or aggra- vated by a woman's pregnancy or its management, so this would exclude some of the opioid-related deaths, the homicides, and possibly some of the suicides," Hollier explained. "But when we talk about Texans being increasingly unhealthy, that contributes significantly to maternal mortality, and pregnancy-related mortality does include women who develop pre- eclampsia more commonly now because they have pre-existing hyper- tension or, for example, because they are older." No quick fixes Where do we go from here? The task force made six major recommendations in their report, half focused on better data collection and analytics and the rest concentrating on improving access and continuity of care, tackling health inequities, and increasing screening for behavioral health services. Already, state-run programs and institutions throughout the Texas Medical Center are working to address some of these issues. The state-funded Healthy Texas Women program, which was intro- duced last year, focuses on helping low-income women gain access to family planning services, STD testing, breast and cervical cancer screenings, postpartum depression screenings, and help with chronic diseases related to obesity, even after their Medicaid benefits from pregnancy expire. Harris Health System offers an OB Navigation Program that provides pregnant patients with enhanced care coordination and support throughout their pregnancy and postpartum period. The Center for Children and Women, which is open to families enrolled in the Texas Children's Health Plan through Texas Children's Hospital, provides a new kind of medical facility that combines a full network of care under one roof—including pediatrics, obstetrics, psychology and more. Children's Memorial Hermann Hospital has increased its focus on preconception and interconception health—the time period between pregnancies—which minimizes risk factors by helping women plan for their pregnancy through education and ongoing access to preventative care. The hospital has also partnered with the March of Dimes to create a new Perinatal Safety Center to research and streamline maternal and infant care. The Texas Department of State Health Services is in the process of establishing an electronic database to track cases of pregnancy-related deaths. And in late May, Texas legis- lators passed Senate Bill 1929, which renewed funding for the task force and outlined specific directives, including postpartum depression services for low-income women. "I am optimistic that we are making progress with improving access to care, and the spotlight that has been shone on the problem will help make it a prior- ity among all the other health care chal- lenges that exist in our state and across the U.S.," Blackwell said. "The issues related to improving maternal mortality in Texas are not quick fixes." Nail it this Father ' s Day. cookiedelivery.com Surprise Dad this Father's Day with the perfect gift: warm cookies, delivered.