Dramatic differences: Why do Black women face a higher maternal morbidity rate than their white counterparts?

Black maternity patients face unique fertility challenges, and a three-times higher maternal mortality risk, compared to their white counterparts, according to U.S. data presented by Dr. Marjorie Dixon, an Ontario obstetrician and gynecologist. Dr. Dixon presented the data, along with tips for physicians with Black fertility patients at the Black Physicians’ Association of Ontario’s (BPAO) Women’s Health conference in November. Her research at the Anova Fertility Clinic looked has sought to shed light on racial disparities in reproductive health. In 2016, Dr. Dixon founded Anova Fertility & Reproductive Health, the leading fertility and in-vitro fertilization center in Canada.“When it comes to their health outcomes, the poorest white woman will fare better than the richest, most well-to-do Black woman,” said Dr. Dixon, echoing a U.S. study revised last year and published in the National Bureau of Economic Research. According to the study, which looked at California birth records, hospitalizations and death records, along with parental tax income records, 350 babies born to the poorest white mothers die before their first birthday, versus 437 babies born to the richest Black mothers.“That gap is widening, and we think it’s because of increased prevalence of risk factors and reduced access to prenatal care,” said Dr. Dixon. Risk factors for Black pregnanciesIncreased morbidity due to preeclampsia, higher risk of stroke, seizures and high risk of both cardiomyopathy and pulmonary edema are five of the risk factors Dr. Dixon said Black women face during pregnancy. “It’s very important to acknowledge and focus on prevention,” said Dr. Dixon. With preeclampsia, which can occur midway through pregnancy (after 20 weeks), mothers typically experience high blood pressure, protein in their pee, swelling, headaches and blurred vision—but it can also occur without symptoms. According to Dr. Dixon, preeclampsia is diagnosed by new onset hypertension with blood pressure greater than 140/90 after 20 weeks with adverse conditions. “So if somebody has blood pressure that’s higher than that before 20 weeks, that’s chronic hypertension,” said Dr. Dixon, adding that hypertensive disorders can affect 14%-to-16% of pregnancies. The current cure for preeclampsia is delivery, said Dr. Dixon, and means that if the condition is affecting the body in a way that needs to be cured to save a patient’s life, it may be done before the baby can survive outside of the uterus. Disparities and short fallsDr. Dixon notes that healthcare systems like those in Canada and the U.S., rely on a data-driven approach to policies and practices, yet there is a racial disparity in infant and maternal care. “Social science literature tells us that race is not a biological category. There’s a lack of a uniform classification system,” said Dr. Dixon. “To use it as a risk factor, the way we use something like a vasulopathy doesn’t make sense.”She recommends a holistic approach to data collection, and to how physicians treat their patients, looking at factors like epigenetics, weathering, biases and societal factors and their impacts on the health of Black women. Epigenetics, which studies how behaviours and environment causes changes to our DNA can be important to understanding the other changes and differences between Black natal health and white counterparts. Weathering is a term coined in 1992 by Dr. Arline Geronimus, who found that white women are most fertile between 20 and 30, while Black women are most fertile in their teens. According to Dr. Geronimus, “The health of African American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.” In general, Dr. Dixon presented data that found that Black women are 1.49 times more likely to have a high allostatic score than a white person, a term used to describe the physical and mental health damage that happens over time because of chronic stress. Preeclampsia incidence is a maker for access to care, according to Dr. Dixon, who said that the widening gap is evidence of a lack of prenatal care for Black women. PreventionWhen it comes to prevention, Dr. Dixon recommended low-dose aspirin. “There is a hallmark trial showcasing that pregnancies last longer and people got less sick if they were treated with aspirin,” she said. The criteria for administering aspirin early in pregnancy that she recommends are: a history of preeclampsia, chronic hypertension, pre-gestational type-1 and type-2 diabetes, kidney disease, autoimmune disease and a combination of multiple moderate risk factors. The American College of Obstetricians and Gynecologists recommends starting patients on aspirin from 11 weeks. “162 milligrams at night, everyday, ideally started before 16 weeks, but there’s also a benefit to starting up to 28 weeks,” said Dr. Dixon. For physicians, she also recommends they monitor their patients calcium, and recommend calcium supplementation if there are deficiencies and advises physicians to recommend 30 minutes of exercise, three times a week, if acceptable. Educating patients about the symptoms of preeclampsia is also important, says Dr. Dixon, who tells her patients to look out for symptoms like headaches, blurry vision, numbness and tingling in their hands and feet. “It’s surprising how many people feel off, and when we check their blood pressure, it’s 140/90 . . . there’s protein in their urine, their liver function is abnormal and they’re starting to develop this disease,” she said.

Dramatic differences: Why do Black women face a higher maternal morbidity rate than their white counterparts?

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