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Race, ethnicity, and nativity affect pregnancy-related mortality in the US

Robin Wulffson MD's picture
pregnancy, mortality, racial discrepancy, ethnic discrepancy, nativity

Although pregnancy-related mortality is low in the United States, race, ethnicity, and nativity differences exist. Researchers from the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC; Atlanta, Georgia) investigated trends in and causes of pregnancy-related mortality by race, ethnicity, and nativity from 1993 to 2006 in the United States. They published their findings in the August 2012 edition of Obstetrics & Gynecology.

The authors note that significant, yet not fully understood, racial, ethnic, and nativity-related disparities exist in women’s health in the United States; furthermore, these disparities include death during and shortly after pregnancy. Most notably, black women have a three to four times higher risk of dying from pregnancy-related causes than white women. For specific mortality causes (i.e., ectopic pregnancy), this gap appears to be even greater. In addition a “Hispanic paradox” exists: research has found that women of Hispanic origin have better pregnancy outcomes than non-Hispanic white women. In addition, a report comparing pregnancy-related mortality of US- and foreign-born women of Hispanic origin notes that a considerably higher mortality rate is present among foreign-born Hispanic women.

About 30% of US women self-identify as members of a racial or ethnic minority group; furthermore, it is estimated that this share will increase to more than half by 2045. Currently, almost half of US births are to women other than US-born non-Hispanic white. The authors note that as the United States becomes more diverse, understanding racial, ethnic, and nativity-related disparities in maternal health becomes an even higher priority. They note that only a handful of studies have explored the associations among race, ethnicity, and nativity and pregnancy-related mortality in the United States. Therefore, they designed a study to estimate and compares trends in and causes of pregnancy-related mortality in the United States by race, ethnicity, and nativity from 1993 to 2006.

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The researchers accessed data from the Pregnancy Mortality Surveillance System. For each race, ethnicity, and nativity group, they calculated pregnancy-related mortality ratios and assessed causes of pregnancy-related death and the time between the end of pregnancy and death. They found that race, ethnicity, and nativity-related minority women contributed 40.7% of all US live births; however, 61.8% of the 7,487 pregnancy-related deaths during 1993–2006 occurred among these women. Pregnancy-related mortality ratios were 9.1 and 7.5 deaths per 100,000 live births among US- and foreign-born white women, respectively; in addition, the rates were slightly higher at 9.6 and 11.6 deaths per 100,000 live births for US- and foreign-born Hispanic women, respectively. Compared to US-born white women, age-standardized pregnancy-related mortality ratios were 5.2 and 3.6 times higher among US- and foreign-born black women, respectively. The researchers noted, however, that causes and timing of death within 42 days postpartum were similar for US-born white and black women with cardiovascular disease, cardiomyopathy, and other pre-existing medical conditions emerging as chief contributors to mortality. Hypertensive disorders, hemorrhage, and embolism were the most important causes of pregnancy-related death for all other groups of women.

The authors concluded, that, except for foreign-born white women, all other race, ethnicity, and nativity groups were at higher risk of dying from pregnancy-related causes than US-born white women after adjusting for age differences. They suggested that integration of quality-of-care aspects into hospital- and state-based maternal death reviews may help identify race, ethnicity, and nativity-specific factors for pregnancy-related mortality.

Take home message:
This study points out disparities in pregnancy-related mortality; however, women of all racial and ethnic backgrounds can reduce their risk of a pregnancy-related death by being proactive about health-related factors during pregnancy. A woman contemplating pregnancy should adopt a healthy lifestyle and heed recommendations from a healthcare professional and/or local public health departments. A healthy lifestyle should be continued throughout pregnancy. Prenatal care should begin early. Select a physician or medical group with good credentials who are affiliated with an accredited medical center.

Reference: Obstetrics & Gynecology