Amy Mhatre-Owens
STATUS OF MATERNAL HEALTH IN THE UNITED STATES
Peer nations that have exceeded performance metrics in healthcare include Japan, Germany, France,
Netherlands, and Switzerland where these nations did better than the United States in terms of maternal
mortality.
The United States has held a poor reputation regarding maternal and infant mortality, and the overall
pregnancy-related negative outcomes are significantly higher when compared to peer countries. 1
Recommended reading - Racial Disparities in Maternal and Infant Health: An Overview
ANNUAL HEALTH CARE EXPENDITURE
OECD data indicates the United States spends similar GDP percentages on public and private
healthcare when compared among peer countries, however, the health outcomes when compared to
others in the OECD were drastically different.
Further analysis of this spending identified that the United States spending is higher because the prices
for healthcare goods and services included pharmaceuticals are much higher compared to the other
nations 2.
PERIODONTITS
Periodontitis is an inflammatory disease affecting the soft and hard structures supporting teeth, and
gingivitis is often an early stage of periodontal disease when the gums become swollen and red due to
this inflammation3.
Caused by poor oral hygiene, this disease can be easily prevented by periodic professional cleanings by
dentists or dental hygienists. It can also be reversed with good oral hygiene, but neglectful oral hygiene
can cause permanent gum tissue destruction, bone resorption around teeth and tooth loss4.
HEALTH DISPARITIES
An imbalance in accessibility and utilization of health services within the United States can be
explained by reviewing the social determinants of health of Americans. Contributors like the place
where people are born, live, learn, work, play, and worship, affect which health services are offered.
These resources are powerful indictors of one’s quality of life and is a significant influencer the
community’s quality of health5.
BLACK MOTHERS AND BABIES ARE DISPROPORTIONATELY DISADVANTAGED
Amongst those burdened with navigating the various social determinants of health, black mothers and
children are more likely to suffer from untreated tooth decay and complications from co-morbidities
due to poor oral care compared to other races and ethnicities within the United States6. In addition,
Black mothers are disproportionately more likely to succumb to pregnancy related mortality and
morbidities. Variability in social determinants of health prevent many black mothers and children from
having equitable quality healthcare7.
BIDEN-HARRIS ADMINISTRATION CALL TO ACTION
Vice President Harris convened a meeting with leaders in healthcare to address the rising
maternal mobility and mortality in the United States. During this meeting which occurred on April
13, 2022 – during Black Maternal Health Week – a historic Call to Action to improve maternal and
infant health outcomes was announced9. The Administration has set out many goals including but
not limited to –
- Extension of Medicaid and CHIP coverage to a full year post-partum under the American Rescue Plan.
- “Birthing-Friendly” Hospital designations for those hospitals that demonstrate a commitment to improvement of maternal and infant health outcomes.
- Commitments to advance maternal health through stakeholder engagement within the health care community.
- Strengthening the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs by advancing innovations to support positive maternal and child health outcomes.
- Implementation of State Maternal Health Innovation and Implementation programs that support the development and implementation of strategies that are proven to be effective.
- Development of maternal health best practices for providers incorporating telehealth care through remote patient monitoring, screening, and treatment for prenatal and postpartum care.
- Investing in Doulas and doubling the Health Start doula programs by hiring, training, certifying and compensating community-based doulas.
Recommended Reading: Fact Sheet: Biden-Harris Administration Announces Additional Actions in
Response to Vice President Harris’s Call to Action on Maternal Health
CONCLUDING REMARKS
Periodontal disease as an inflammatory condition in pregnant women and its association with poor
health outcomes in mothers and babies is supported by literature10-13. Clinical practice shows
periodontitis is preventable if symptoms are detected early, and infections are mitigated quickly.
Social determinants of health also show that pregnant women often have many barriers to
receiving optimal attention to their oral health needs14, 15. We know that early detection and
intervention of periodontitis requires routine and recurrent dental visits, thus encouraging pregnant
women to maintain their preventative dental visits during pregnancy could be a way to avoid the
proliferation of gingival disease and mitigate poor pregnancy outcomes. Highlighting this
preventative service as a necessary mitigation practice in prenatal care could help slow down the
poor maternal and child outcomes and support the movement toward a healthy nation in 2030.
REFERENCES AND READINGS -
1. Nisha Kurani EW. How does the quality of the U.S. health system compare to other countries? KFF. 2021.
2. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. It's the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood). 2003;22(3):89-105. Epub 2003/05/22. doi: 10.1377/hlthaff.22.3.89. PubMed PMID: 12757275.
3. Beck JD, Papapanou PN, Philips KH, Offenbacher S. Periodontal Medicine: 100 Years of Progress. J Dent Res. 2019;98(10):1053-62. doi: 10.1177/0022034519846113. PubMed PMID: 31429666.
4. Slots J. Periodontitis: facts, fallacies and the future. Periodontol 2000. 2017;75(1):7-23. doi: 10.1111/prd.12221. PubMed PMID: 28758294.
5. Promotion OoDPaH. Social Determinants of Health 2022 [2022-04-17]. Available from: https://health.gov/healthypeople/priority-areas/social-determinants-health.
6. Disparities in Oral Health | Division of Oral Health | CDC2021.
7. CDC. Working Together to Reduce Black Maternal Mortality 2022 [cited 2022 April 17]. Available from: https://www.cdc.gov/healthequity/features/maternal-mortality/index.html.
8. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM, Barfield W. Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2019;68(35):762-5. Epub 20190906. doi: 10.15585/mmwr.mm6835a3. PubMed PMID: 31487273; PMCID: PMC6730892.
9. @whitehouse. Fact Sheet: Biden-Harris Administration Announces Additional Actions in Response to Vice President Harris’s Call to Action on Maternal Health | The White House. @whitehouse; 2022.
10. Saadaoui M, Singh P, Al Khodor S. Oral microbiome and pregnancy: A bidirectional relationship. J Reprod Immunol. 2021;145:103293. Epub 20210219. doi: 10.1016/j.jri.2021.103293. PubMed PMID: 33676065.
11. Gil-Montoya JA, Leon-Rios X, Rivero T, Exposito-Ruiz M, Perez-Castillo I, Aguilar-Cordero MJ. Factors associated with oral health-related quality of life during pregnancy: a prospective observational study. Qual Life Res. 2021. Epub 2021/05/13. doi: 10.1007/s11136-021-02869-3. PubMed PMID: 33978891.
12. Micu IC, Roman A, Ticala F, Soanca A, Ciurea A, Objelean A, Iancu M, Muresan D, Caracostea GV. Relationship between preterm birth and post-partum periodontal maternal status: a hospital-based Romanian study. Arch Gynecol Obstet. 2020;301(5):1189-98. Epub 2020/04/11. doi: 10.1007/s00404-020-05521-6. PubMed PMID: 32274638.
13. Micu IC, Bolboacă SD, Caracostea GV, Gligor D, Ciurea A, Iozon S, Soancă A, Mureșan D, Roman A. Selfreported and clinical periodontal conditions in a group of Eastern European postpartum women. PLoS One. 2020;15(8):e0237510. Epub 20200818. doi: 10.1371/journal.pone.0237510. PubMed PMID: 32810155; PMCID: PMC7433868.
14. Dave BH, Shah EB, Gaikwad RV, Shah SS. Association of preterm low-birth-weight infants and maternal periodontitis during pregnancy: An interventional study. J Indian Soc Pedod Prev Dent. 2021;39(2):183-8. Epub 2021/08/04. doi: 10.4103/jisppd.jisppd_270_20. PubMed PMID: 34341239.
15. Tefiku U, Popovska M, Cana A, Zendeli-Bedxeti L, Recica B, Spasovska-Gjorgovska A, Spasovski S. Determination of the Role of Fusobacterium Nucleatum in the Pathogenesis in and Out the Mouth. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2020;41(1):87-99. Epub 2020/06/24. doi: 10.2478/prilozi-2020-0026. PubMed PMID: 32573481.
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