COMMENTARY

The Real Reasons for Maternal Mortality Disparities

Andrew M. Kaunitz, MD

Disclosures

May 19, 2021

This transcript has been edited for clarity.

We have known for decades that rates of maternal mortality in the US are higher among minority women, a disparity often attributed to personal medical and behavioral factors.

Severe maternal morbidity (SMM) is 100 times more frequent in African American women. Three new reports examine racial disparities in the incidence of SMM. Each of these studies then assesses the relative contributions of maternal risk factors compared with social, health system, and environmental factors in explaining these disparities.

In the first study, researchers used New York City birth data to assess the role of prepregnancy obesity in the association between race and SMM. Compared with women with a normal BMI, the rate of SMM was almost 60% higher in obese women and almost three times higher in Black women than in White women.

Importantly, however, only 3% of the association between Black race and SMM could be attributed to obesity.

In another study, investigators used data from a Northeastern urban academic health system to evaluate the association between individual and neighborhood risk factors and SMM. Among more than 63,000 pregnancies, the incidence of SMM was just under 3%.

For every 10% increase in the percentage of individuals in a census tract identified as Black or African American, the rate of SMM increased by 2%.

In a third study, investigators reviewed national inpatient data on almost 75 million deliveries from 1999 to 2017 to discover trends in SMM and related mortality. Although the overall incidence of SMM declined during this period, maternal deaths continued to be almost twice as frequent in Black as in White women.

The authors pointed out that maternal deaths among women with SMM reflect hospital characteristics including preparedness, timely recognition, and speed of clinical response, concluding that where care was delivered makes important contributions to disparities in outcomes.

These three studies defy popular assumptions that unhealthy lifestyle choices are responsible for higher rates of SMM and maternal mortality among Black women.

Instead, environmental and hospital-based factors play key roles in perpetuating these disparities, underscoring that improving maternity care can reduce excess morbidity and mortality in African American women.

Thank you for the honor of your time. I am Andrew Kaunitz.

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