Photo Credit: Svetlana Larshina

Compared with White patients, Black patients experience higher rates of maternal mortality, pregnancy-related mortality, stillbirth, and preterm birth.

Risks of maternal mortality and adverse pregnancy outcomes are higher in US residents who are Black compared with those who are White, with even greater racial disparities occurring in counties with higher social vulnerability, according to findings published in Obstetrics & Oncology.

“Black individuals in highly vulnerable counties face disproportionate risks for maternal mortality rate, pregnancy-related mortality, stillbirth, and preterm birth. Health care professionals may consider incorporating tools such as the SVI [Social Vulnerability Index] to identify patients at high risk and to tailor interventions accordingly,” Tetsuya Kawakita, MD, MS, and colleagues wrote.

The cross-sectional study analyzed adverse pregnancy outcomes for Black and White individuals aged 15 to 44 years across 3,114 counties in the US. The researchers used deidentified datasets from the CDC to investigate county-level natality, fetal death, and all-cause mortality and grouped patients into social vulnerability quartiles based on county-level SVI.

Differences Based on Social Vulnerability

The study included 20.2 million people. Among them, 2.6 million were in the first SVI quartile (lowest vulnerability), 4.9 million were in the second SVI quartile, 6.8 million were in the third SVI quartile, and 5.9 million were in the fourth SVI quartile (highest vulnerability).

Regardless of SVI quartile, rates of maternal mortality (death while pregnant or within 42 days of the end of pregnancy), pregnancy-related mortality (maternal death resulting from any cause related to pregnancy up to 1 year after delivery), stillbirth, and preterm birth were significantly higher among Black individuals compared with White individuals, according to the study results.

Dr. Kawakita and colleagues conducted difference-in-difference analyses to measure the difference in outcomes between Black and White individuals across levels of social vulnerability. With the least vulnerable counties serving as the reference group, disparities in maternal mortality rates were significantly larger in the second, third, and fourth SVI quartiles, the study found. Adjusted difference-in-difference estimates for maternal mortality rate per 100,000 live births were 14.22 for the second quartile, 12.53 for the third quartile, and 18.82 for the fourth quartile.

“A worsening disparity in pregnancy-related mortality was observed in the fourth quartile, whereas disparities in stillbirth and preterm birth did not show significant differences across SVI quartiles,” the researchers wrote.