Biological factors, such as higher rates of preexisting chronic disease prior to pregnancy, fail to fully account for differences in outcomes.
[5] There is a lack of evidence to support a genetic difference between racial groups as a cause of maternal health disparities such as preterm birth.
[6] Social factors, such as structural racism, have been suggested as a contributory cause of the wide racial disparities in maternal health in the United States.
[9] Studies of potential biomarkers of allostatic stress have failed to date to demonstrate the racial group differences seen with self-report measures.
[5] The effects of implicit and explicit provider bias in obstetrical care has been poorly studied and may contribute to disparate outcomes.
[1] Some states are utilizing federal block grant money for initiatives targeting reductions in maternal morbidity and mortality for Black and Hispanic women.
[14][15] Recommendations for appropriate use of race as a research variable may limit use of white normative standards in the future, which can imply non-white people as being atypical.
[16] Proposed alternative variables for race may be genetic ancestry, socioeconomic factors, or differential opportunities.
[20] While limited research is available about the reproductive system effects of environmental pollutants, evidence from animal models indicates risks to humans.
[21] Black families are more likely to live in neighborhoods with poorer air quality and higher rates of heavy metal contaminants.
[22] Heavy metals such as lead and mercury are known neurotoxins and the developing fetal nervous system may be particularly vulnerable to excessive levels.
[25][24] Strategies to improve pregnancy outcomes through behavioral interventions like folic acid supplementation and smoking cessation may be too little too late, as many women enter prenatal care several weeks into sensitive fetal development.
[33] Asian people are also at higher risk of diabetes compared to white people, and subgroup analysis indicates that those who identify as South Asian (Indian, Pakistani, Sri Lankan, Bangladeshi, Nepali, or Bhutanese) have the highest prevalence of diabetes.
[35] Women with BMI greater than 40 during pregnancy are at increased risk for fetal cardiac defects and comorbidities such as hypertension, hyperlipidemia, and obstructive sleep apnea.
[37] Many of the quality measures included in indices of prenatal care lack established correlations to improved maternal health outcomes.
[36] Black, Hispanic and Native American women are more likely to report site-related barriers to receiving prenatal care, such as distance to the clinic and lack of transportation to appointments.
[40] The Weathering Hypothesis, first described by Arline Geronimus, has been proposed as the neuroendocrine immune pathway by which Black women experience this higher rate of early pregnancy loss.
[41][42] Racial disparities in pregnancy loss after the completion of 20 weeks of gestation, or stillbirth, have been documented in the United States since at least as early as 1918.
[46] While racial and ethnic groups including Hispanic, Native American, African, and Australian Aboriginal women are often reported to be at increased risk of developing gestational diabetes, racial disparities could be succinctly summarized as increased risk for women who identify as non-white.
[72] Black, Asian, and Pacific Islander women are at increased risk of hysterectomy due to postpartum hemorrhage compared to white or Hispanic women[72] Cardiovascular severe maternal morbidity encompasses pre-existing conditions, such as valvular heart disease, and pregnancy-related conditions, such as pre-eclampsia and peripartum cardiomyopathy.
[76] Medical professionals are less likely to listen to the concerns of pregnant African American women, which leads to them feeling less comfortable with the staff or discouraged to speak up.
For example, 23 grand slam winner Serena Williams almost lost her life due to post-birth complications that the medical staff ignored.
During the COVID-19 pandemic, new Black mothers showed signs of lagging adaption to the changing healthcare system which resulted in an increase in postpartum complications.
[78] Preeclampsia is also associated with greater likelihood of postpartum hospital readmission; Black women are at disparate risk of developing pre-eclampsia.
[79] The experience of postpartum depression in women of color is likely complicated by discrimination, increased risk of adversities such as poverty, and decreased access to resources.
[94] Likely historical oppression and racist practices contribute to decreased breastfeeding rates in Black and Native American communities.