African-American women at higher risk of pregnancy-related death

African-American women are dying from pregnancy-related complications three times more frequently than any other racial group, according to new Centers for Disease Control and Prevention data. Deaths within one year of pregnancy typically occur from complications such as blood clots, hemorrhage and heart problems.

“Pregnancy is a joyful time, but not without its risks,” says Dr. Renée Volny, obstetrician-gynecologist and a health policy fellow at The Satcher Health Leadership Institute in Atlanta. “Pregnancy puts physical stress on some of the body’s vital organs.”

Early prenatal care is the most important way a woman can prevent her risk of pregnancy-related death. African-American mothers are almost three times more likely than white mothers to wait until the third-trimester to seek prenatal care, or not at all. Of those who have no prenatal care, the risk of death is five times greater.

“Without the proper risk assessment by a doctor, a woman may not realize that a pregnancy could put her life at risk,” said Dr. Volny. “This is why women should try to see a doctor well before they actually get pregnant.”

In fact, the study authors explain that some of the women’s pre-pregnancy health conditions were just as important risk factors in pregnancy-related death.

Once pregnant, early prenatal care can diagnose potentially fatal illnesses. One in particular, ectopic pregnancy — where the fetus implants outside of the uterus, usually in the fallopian tube — can quickly lead to major hemorrhage and death. African-American women are actually more likely to die from ectopic pregnancy than other pregnant women. However, with early prenatal care, including ultrasound, the condition can be diagnosed and treated before it becomes fatal.

Like most health conditions that affect low socioeconomic or minority populations, access to care is the common theme. If a woman cannot obtain regular and quality prenatal care, or cannot find transportation to that care, then she will fall into the high-risk group, both for the health of the unborn child as well as her own.

However, a small Wisconsin study suggests that access to care is not the only issue. The researchers surveyed African-American mothers and found that perceived racism or expectations of racism often led to avoidance of prenatal care. More research is needed to fully ascertain if this is a widespread problem in other parts of the United States.

The overall numbers of pregnancy-related deaths across all women has increased, higher than any period in the last 20 years. The authors admit the increase may be due to better reporting of these cases on death certificates or in registries, as compared to older, more inconsistent record-keeping. This does not, however, explain the disparity that remains among African-American pregnant women.

Dr. Volny is still hopeful, and does not believe these statistics are indicative of future death rates, particularly under the new health care reform law. “With its passing, almost every mother will have health insurance, which will remove at least one barrier of accessing preconception counseling and prenatal care.”