The American Heart Association (AHA) announces a Request for Applications (RFA) for the Health Equity Research Network (HERN) on Disparities in Maternal-Infant Health Outcomes.
The United States has the highest maternal mortality rate among industrialized countries, and cardiovascular disease is the leading cause of pregnancy-related mortality in the U.S. (Mehta et al., Circulation, 144:e251, 2021). Major racial disparities exist in maternal health outcomes. Black women experience pregnancy-related death at a rate 2.5 times higher than White women and 3.5 times higher than Hispanic women, and American Indian/Alaska Native women experience pregnancy-related death more than twice as often as White women (Hoyert, NCHS Health E-Stats, 2021). While educational attainment is often a health protective factor, research suggests this may not be the case with maternal mortality. College-educated Black women are still at higher risk than White and Hispanic women with less than a high school diploma, and Black college-educated women are five times as likely to die than White college-educated women (Petersen et al., Morbidity and Mortality Weekly Report, 68(35), 2019; Bond et al., Circ Cardiovasc Qual Outcomes, 14:e007643, 2021).
Structural racism in the healthcare system can impact how Black women are treated during pregnancy and postpartum care (Taylor, Journal of Law, Medicine & Ethics, 48(3), 2020) and the chronic stress associated with racism has been shown to be tied to cardiovascular disease (Churchwell, et al., Circulation, 142: e454, 2020). Research has begun to explore how social determinants of health (SDOH) impact individuals’ risk of cardiovascular disease, and suggests adverse SDOH are linked to higher CVD risk factors (Jilani, et al., Curr Atheroscler Rep, 23(9): 55, 2021; Mannoh, et al., Curr Opin Cardiol, 36(5): 572, 2021), but further research is needed to understand this connection. Geographic disparities also exist, with women living in rural communities experiencing higher mortality rates than women living in urban communities (Harrington, et al., Circulation, 141:e615, 2020).
Racial disparities exist for infant mortality rates as well, with Black babies having an infant mortality rate of 10.8 deaths per 1,000 live births compared to 4.6 deaths for White babies (Ely & Dirscoll, National Vital Statistics Reports, 69(7), 2020). Racism and other chronic stressors also impact birth outcomes, often leading to low birth weight or preterm birth (Braveman, et al., PLoS One, 12: e0186151, 2017), which are the leading causes of infant mortality and often lead to long-term cognitive developmental health issues (Farooqi, et al., PLoS One, 11:e0151819, 2016; Taylor, Semin Perinatol, 40: 529, 2016). Interestingly, new research suggests that when Black newborns are cared for by a Black physician as compared to a White physician, the rate of infant mortality is cut in half (Greenwood, et al., PNAS, 117(35): 21194, 2020). Additional research is needed to more fully understand how structural racism and racial disparities manifest and can be addressed with regard to maternal and infant morbidity and mortality.
Defining additional opportunities for improvements in delivery of care are also needed. For example, cardio-obstetrics is a multidisciplinary field that takes a team approach to addressing cardiovascular disease during pregnancy and can help prevent maternal mortality (Mehta, et al., Circulation, 141, 2020). As an additional example, research suggests doula care is beneficial for improving maternal health outcomes (Bohren, et al., Chochrane Database Syst Rev., 7(7): CD003766, 2017), and in particular, race and/or cultural concordance between doulas and birthing mothers is beneficial in building a trusting relationship and helping to mitigate the institutional biases often faced by Black mothers in the health system (Wint, et al., Health Equity, 3(1): 109, 2019). The ability of many women to access doula care remains insufficient, however (https://www.healthaffairs.org/do/10.1377/forefront.20210525.295915/full/). Further building the evidence base for this and other interventions and approaches to care may facilitate changes in policy resulting in substantially improved outcomes.
In addition to the social and structural factors that impact disparities in maternal health outcomes, biological factors may have an important role. As an example, preeclampsia, a pregnancy-specific disease characterized by high blood pressure, increased protein levels and other factors, occurs in approximately 5% of pregnancies and is a major contributor to mortality and morbidity. The precise mechanism(s) underlying preeclampsia remains unclear, although a number of likely contributing factors have been identified (Chaiworapongsa et al., Nat Rev Nephrol 10(8): 466, 2014). Its prevalence is significantly higher in Black women and in Alaska Native and American Indian women compared to non-Hispanic white women (see Johnson and Louis, Am. J. Obstet. Gynecol doi: 10.1016/j.ajog.2020.07.038, 2020 and references therein). The ability to accurately predict susceptibility to likelihood of mothers developing preeclampsia could minimize these disparities and improve outcomes for all mothers. Whereas there has been some progress in this area, lack of knowledge of biomarkers of preeclampsia and other conditions that increase the likelihood of poor outcomes with pregnancy remains a significant limitation in maternal care (MacDonald et al., EBioMedicine 2022;75:103780).
Pre-proposal Deadline: March 8, 2022