This is third in a series of four (likely 5 after Nick Kristof’s unresearched piece in the Sunday New York Times this past Sunday). The second piece went further in depth on the differences, including how they aren’t well studied, which I suspect is part easily observed risk known to OB’s and therefore requiring little study to prove and unwelcome knowledge from a popular, lay perspective. From that piece:
The medical textbooks define advanced maternal age as 35, but the assorted heightened risks to the mother — which include gestational diabetes, thyroid dysfunction, high blood pressure, complications resulting in cesarean sections, injuries resulting from vaginal birth, cardiac events, and stroke — begin to rise after 30. They climb steeply after 35. And note, these risks compound. High blood pressure or gestational diabetes each make a c-section more likely, and a c-section for one birth makes a c-section for subsequent births far more likely. But this data gets, at best, a passing mention in popular source discussions of rising MMR or pregnancy in general. (It doesn’t get that much more study in the professional literature, either.)
And a few paragraphs later, I quoted the relevant portion of the Gates report from which most of the pop coverage has cherry picked its stats and quotes.
Fourth, the highest SDI geographies [wealthy, medically advanced nations like the US and the UK] are likely also experiencing a confluence of factors leading to higher-risk pregnancies and subsequently higher than expected MMR — namely, delay of fertility to older ages and a corresponding increase in the proportion of pregnant women with non- communicable diseases (NCDs). Other direct maternal disorders are the dominant cause of maternal death in high SDI locations, driven by cardiomyopathy and obstetric embolism, both of which are of higher risk in older women and those with preexisting conditions such as hypertension, obesity, and diabetes. If the trend of increasing NCDs continues and, barring any breakthrough in preventing such complications, we could reasonably expect to see MMR increases begin to emerge in other regions besides those in the highest SDI.
The whole thing is here. And if you are curious, the fourth piece is on the Texas problem. (I have not yet decided how to publish the fifth piece as maternal mortality is an example, a causality, of elite signaling snubbing accuracy. Harvard grad and long time Times columnist publishes Sunday article and it is taken at face value without even basic research. If “America doesn’t care about its mothers as much as Britain” wasn’t the conventional wisdom, it is now, even though the facts tell a different story.)