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