The Most Common Causes for Maternal/Fetal Morbidity 

July 26, 2022

A 2021 Research Study by the National Institute of Health (NIH) shows the following causes for maternal/fetal morbidity in the U.S. including probable causes for the racial disparity.



Placental Abnormalities

· This risk is greatest for preterm fetuses. Cocaine use, smoking, hypertension, and preeclampsia increase the risk for placental abruption and stillbirth.


· Diabetes increases stillbirth risk up to five times

· In type 2 diabetics, the stillbirth rate is 22.9/1000 births. A higher BMI (OR 1.07) and elevated glycosylated hemoglobin before pregnancy (OR 1.02) were associated with stillbirth. 


· Non-Hispanic, black women in the U.S. have a higher rate of stillbirth (11 per 1000 births) compared to other racial groups. This group also has a higher incidence of diabetes, hypertension, premature membrane rupture, and abruption may account for the higher rate of stillbirth

· Hispanic women in the U.S. also have a higher rate of stillbirth than non-Hispanic white women.


· Obesity is an independent risk factor for stillbirth, even after controlling for diabetes, smoking, gestational diabetes, and preeclampsia. Obesity is a major health problem in developed countries and is defined as a body mass index greater than 30 kg/m2. Obese women are 1.5 times more prone to stillbirths than nonobese women.

Substance Misuse

· The most common finding in pregnancy complicated by substance use is growth restriction. Placental dysfunction, vasoconstriction, hypoxia, are attributed to the increased risk of stillbirth associated with substance misuse.

· Smoking, alcohol, and illicit drugs


· Chronic hypertension increases stillbirth risk three-times.

Late-Onset Prenatal Care

· Late-onset prenatal care and prior home delivery without postpartum care are independent risk factors for subsequent adverse perinatal outcomes.


· Even in developed countries, infection accounts for 19% of stillbirths before 28 weeks, Non-bacterial organisms causing stillbirth included cytomegalovirus 8%, parvovirus 3%, syphilis 2%, and herpes simplex virus 2%.

Prenatal Care and History

· The social history should include employment, nutrition, substance use, domestic violence, and travel history.

· Access to Prenatal vitamins including folic acid and Prenatal lab tests should include CBC, type and screen, HbsAg, syphilis, HIV, rubella, urine toxicology, and diabetic screening.

· Frequent Screening of weight, blood pressure, blood sugar and infections


Reference and review the Blue Cross and Blue Shield of Texas (BCBSTX) Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps THSteps for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.