Approximately 700 women die in the United States each year as a result of pregnancy or its complications; and significant racial and ethnic disparities in pregnancy-related mortality exist. Data from CDC’s Pregnancy Mortality Surveillance System (PMSS) for 2007–2016 analyzed. Pregnancy-related mortality ratios (PRMRs); analyzed by demographic characteristics and state PRMR tertiles; cause-specific proportionate mortality by race/ethnicity also was calculated. Over the period analyzed, the U.S. overall PRMR was 16.7 pregnancy-related deaths per 100,000 births.
Black and American Indian/Alaska Native (AI/AN) women have significantly higher pregnancy-related mortality ratios (PRMRs) than whites, according to research published in the Sept. 6 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Emily E. Petersen, M.D., from the CDC in Atlanta; and colleagues analyzed data from the CDC Pregnancy Mortality Surveillance System for 2007 to 2016. PRMRs analyzed by demographic characteristics and state PRMR tertiles.
Black and AI/AN women
The researchers found that the overall PRMR; 16.7 pregnancy-related deaths per 100,000 live births. Compared with all other racial/ethnic groups, non-Hispanic black and non-Hispanic AI/AN women experienced higher PRMRs (40.8 and 29.7, respectively). Over time and across age groups, this disparity persisted. For black and AI/AN women aged ≥30 years, the PRMR was about fourfold to fivefold higher than for their white counterparts. Black and AI/AN women with at least some college education had PRMRs that were higher than those for all other racial/ethnic groups with less than a high school diploma.
Among state PRMR tertiles, compared with non-Hispanic white women, black and AI/AN women had PRMRs that were 2.8 to 3.3 and 1.7 to 3.3 times higher, respectively. Racial/ethnic disparities in pregnancy-related mortality were evident in 2007 and continued through 2016, with significantly higher PRMRs among black and AI/AN women than among white, A/PI, and Hispanic women. The PRMR for black and AI/AN women aged ≥30 years was approximately four to five times that of their white counterparts.
Even in states with the lowest PRMRs, and among groups with higher levels of education; significant disparities persisted, demonstrating that the disparity in pregnancy-related mortality for black and AI/AN women is a complex national problem. Quality of care likely has a role in pregnancy-related deaths and associated racial disparities. However, a national study of five specific pregnancy complications found a similar prevalence of complications among black and white women; but a significantly higher case-fatality rate among black women.
Racial andethnic disparities
Studies have suggested that black women are more likely than are white women to receive obstetric care; in hospitals that provide lower quality of care. “Further identification and evaluation of factors contributing to racial andethnic disparities are crucial to inform and implement prevention strategies that will effectively reduce disparities in pregnancy-related mortality; including strategies to improve women’s health and access to quality care in the preconception, pregnancy, and postpartum periods,” the authors write.
Most pregnancy-related deaths prevented; and significant racial/ethnic disparities in pregnancy-related mortality need to be addressed. Further identification and evaluation of factors contributing to racial/ethnic disparities are crucial to inform; and implement prevention strategies that will effectively reduce disparities in pregnancy-related mortality, including strategies to improve women’s health and access to quality care in the preconception, pregnancy, and postpartum periods. Addressing this complex national problem requires coordination and collaboration among community organizations; health facilities, patients and families, health care providers, and health systems.