Why African-American women are at greater risk for pregnancy-related death.
OBJECTIVE
Our study aim was to identify factors that may contribute to the racial disparity in pregnancy-related mortality.


METHODS
We examined differences in severity of disease, comorbidities, and receipt of care among 608 (304 African-American and 304 white) consecutive patients of non-Hispanic ethnicity with one of three pregnancy-related morbidities (pregnancy-related hypertension, puerperal infection, and hemorrhage) from hospitals selected at random from a statewide region.


RESULTS
African-American women had more severe hypertension, lower hemoglobin concentrations preceding hemorrhage, more antepartum hospital admissions, and a higher rate of obesity. The rate of surgical intervention for hemorrhage was lower among African-Americans, although the severity of hemorrhage did not differ between the two racial groups. More African-American women received eclampsia prophylaxis. After stratifying by severity of hypertension, we found that more African-Americans received antihypertensive therapy. The rate of enrollment for prenatal care was lower in the African-American group. Among women receiving prenatal care, African-American women enrolled significantly later in their pregnancies.


CONCLUSIONS
We have identified racial differences in severity of disease, comorbidities, and care status among women with pregnancy-related complications that would place African-Americans at disadvantage to survive pregnancy. These differences are potentially modifiable.
Harper
Margaret
M
Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA. mharper@wfubmc.edu
Dugan
Elizabeth
E
Espeland
Mark
M
Martinez-Borges
Anibal
A
Mcquellon
Cynthia
C
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000401:mortality*; D011295:Prenatal Care / Q000706:statistics & numerical data