The Intersection of Nativity With Race and Ethnicity in Preeclampsia—Broadening the Assessment of Social Determinants of Maternal Health

Abstract

There are approximately 4 million births annually in the US, and approximately 1 in 5 of these births are complicated by 1 or more interrelated adverse pregnancy outcomes (APOs), including preeclampsia, preterm delivery, and birth of an infant who is small for their gestational age. 1 APOs are increasing in incidence, have shared upstream risk factors, and have important health implications for both the birthing person and offspring. Numerous studies have demonstrated the associations between APOs and increased risk for maternal and neonatal morbidity and mortality. The pathophysiologic processes leading to APOs begin before conception and are, in part, associated with maternal cardiovascular risk factors (eg, obesity, hypertension) present before pregnancy. 2 Evolving evidence implicates social, structural, and systemic factors as upstream determinants of health associated with the significant and pervasive racial and ethnic disparities in maternal health outcomes, with higher rates of prepregnancy cardiovascular risk factors, APOs, and postpartum cardiovascular disease (CVD) in non-Hispanic Black individuals compared with non-Hispanic White individuals. Such factors include adverse life events and stressors, socioeconomic status at the individual and neighborhood level, and experiences of racism and discrimination. Beyond these

Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training

“…Given the disparities in maternal health, there is a need for greater advocacy at institutional, state, national, and international levels to improve cardiovascular care of women during and after pregnancy. 18 19 21 22 30 This includes forming and participating in institutional and state/federal maternal mortality and morbidity review committees and engagement in national and international professional and foundational societies. Formal training in cardio-obstetrics provides education across disciplines and a fresh perspective on the heterogeneous and complex care required for optimal outcomes.…”

Diverse Perspectives to Support a Human Rights Approach to Reduce Indiana’s Maternal Mortality Rate

“…While research reveals the major medical causes of maternal mortality (Collier and Molina 2019), more recent studies examined social determinants of (i.e. environmental, social, and economic conditions that surround) poor maternal health outcomes (Crear-Perry et al 2021; Gadson, Eloho, and Mehta 2017; Shah, Kershaw, and Khan 2021). A recent review of literature on the social determinants of maternal mortality offered strong evidence of the role of race and ethnicity, insurance, and education in maternal deaths, but noted “a lack of diversity in the social determinants of health and maternal outcomes literature, including the type of determinants studied, type of study design, and exploration of potential mechanism that underlie the observed association” (Wang et al 2020:911).…”