Despite more women seeking prenatal care during the first trimester of pregnancy, black women and Latinas continue to experience higher rates of miscarriage and infant death compared with whites, a study being released today says.
The research suggests that factors besides being seen by a doctor early—anything from stress to not following doctors’ orders—may be playing a role in why minority women are not faring as well in pregnancy.
“It’s more than just showing up at the doctor’s office that leads to improved outcomes. . . We don’t have all the answers and need to find out what is going on,” said Andrew J. Healy, the study’s lead author, who is doing his training in maternal-fetal medicine at Columbia University Medical Center.
To conduct their study, Healy and his fellow researchers reviewed the records of 35,529 pregnant women at 15 U.S. sites who contacted a doctor during the first trimester between 1999 and 2002. A total of 68 percent of the women were white, 22 percent were Hispanic, 5 percent were black and 5 percent were categorized as “other.”
Researchers monitored pregnancy loss at three intervals—less than 24 weeks of pregnancy, more than 24 weeks and at the time of birth.
Healy said the study did not look at how consistent women were with their prenatal visits or assess the quality of those visits, two factors he admitted could influence a woman’s pregnancy.
Overall, 1.3 percent of the pregnancies ended in miscarriage or newborn death. Minorities experienced the highest rate of loss. For every 1,000 pregnancies, there were 42 pregnancy losses for blacks, 15.9 for Hispanics, 16.6 for persons classified as “other,” and 10 for whites.
While blacks comprised only 5 percent of the study sample, they accounted for 16 percent of the miscarriages and infant deaths.
“We couldn’t explain why minorities still had the increase in pregnancy loss,” Healy said, explaining that researchers controlled for factors such as age, education and marital status.
The study did note, however, that the minority women whose records were reviewed had a higher rate of pre-existing health conditions such as diabetes, high blood pressure and obesity. They also tended to smoke more.
In Essex County, for example, the infant mortality rate for blacks is 14.5 percent, compared with 3.6 percent for whites, according to 2003 statistics, the latest available.
“Affluent black women are at risk of losing their infants, too,” said Ilise Zimmerman, president and CEO of the Northern New Jersey Maternal Child Health Consortium.
“Access may be a start, but it’s not the whole story,” said Kurt Barnhart, a University of Pennsylvania professor who works on health care issues affecting under-served women for the American College of Obstetrics and Gynecology.