Better prenatal care data could help prevent maternal complications

Widely used measures of prenatal care may give the appearance of adequate care while missing critical opportunities to prevent maternal complications.

But upcoming changes to prenatal care billing and quality reporting could help reshape how prenatal care is measured and improve the ability to address risks before they become emergencies, according to a new Michigan Medicine-led commentary in Obstetrics & Gynecology, The Green Journal.

Prenatal care reaches more than 98% of people who give birth in the United States, authors point out, giving clinicians repeated chances to manage risks and prevent complications during pregnancy.

“Our maternal morbidity rate in the U.S. is unacceptably high,” said lead author Alex Peahl, M.D., MS.c., an obstetrician-gynecologist and researcher at University of Michigan Health Von Voigtlander Women's Hospital.

“You cannot improve what you do not measure, and we need to measure what matters. Preventing adverse outcomes for birthing people and their families requires a paradigm shift in how we capture prenatal and postpartum data.”

Prenatal care can look adequate while critical needs go unmet
Despite prenatal care’s critical role in preventing maternal morbidity, current measures provide a limited picture of its quality, the authors say.

These measures largely focus on when prenatal care begins and how many visits a patient receives.

While those metrics show whether someone accessed care, they don't show whether the patient received the care they needed.

The researchers illustrate the gap through a hypothetical patient, Taylor.

Taylor starts prenatal care within the recommended window and attends the expected number of visits.

By conventional measures, her care appears adequate.

But a closer look tells a different story: Taylor does not receive aspirin that could help prevent preeclampsia. Doctors diagnose her with anemia, but it’s not effectively treated because she cannot afford the recommended therapy. Her mental health and social needs are identified but not followed up.

“Counting visits tells us that someone came through the door,” Peahl said.

“It does not tell us whether we identified their risks, delivered the right interventions at the right time, addressed barriers to treatment or connected them with the support they needed.”

Prenatal care offers multiple points to prevent complications, she points out.

Screening and managing conditions such as anemia, for example, can reduce the risk of serious complications like postpartum hemorrhage.

Identifying medical and social risk factors early can also help clinicians intervene before problems escalate.

But claims and electronic health record data often lack the detail needed to determine whether clinicians recognized and acted on those risks while providing limited and inconsistent information about social needs, patient experiences and other factors that influence outcomes.

Billing changes could make prenatal care more visible

Upcoming changes to the way maternity care is billed could improve that picture.

Beginning in January 2027, maternity care professionals will be able to bill separately for prenatal evaluation and management services rather than relying on the traditional bundled approach.

Clinicians will also be able to do this for services such as remote monitoring, social needs and depression screening and counseling.

“Unbundling obstetric care could provide greater visibility of the services patients receive during pregnancy,” Peahl said.

Changes in quality reporting could further strengthen the data.

A federal policy requiring hospitals to transition to digital quality measurement by 2030 could create more detailed datasets for quality improvement and make it easier to bring together laboratory, pharmacy, radiology and other clinical information.

From measuring care to preventing harm

But better data and measurement are the starting point, authors say.

Clinicians, payers, health systems and policymakers will need consistent approaches to collecting, standardizing and sharing prenatal care data.

A more coordinated approach, Peahl says, could eventually create a more complete picture of the factors affecting maternal and neonatal health.

“New policy changes can improve the completeness and quality of national data, but we need significant investment and coordination to ensure these data are useful,” Peahl said.

Study: Improving Pregnancy Outcomes Through Better Prenatal Care Data and Metrics (DOI: 10.1097/AOG.0000000000006437)