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››Pregnancy in times of pandemic: inequalities in maternal health

Pregnancy in times of pandemic: inequalities in maternal health

By Evan Cooper
January 26, 2022
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The COVID-19 pandemic and resulting health service changes have exacerbated the global number of negative maternal and perinatal outcomes. Using data from electronic health records, a study by Piekos and colleagues found that mild to moderate SARS-CoV-2 infection in early pregnancy led to an increased risk of preterm birth and stillbirth, emphasizing the importance of prioritizing pregnant women for COVID-19 vaccination. However, the pandemic has also elucidated social and racial disparities in these outcomes; a rapid report from MBRRACE-UK found that six out of ten women examined who died during or after pregnancy from COVID-19 or its complications were from black or minority ethnic groups.
Such disparities have already been recognized as playing a role in adverse pregnancy outcomes. Using data from 2017 to 2019, findings from a report on maternal deaths and morbidity from MBRRACE-UK showed persistent inequalities in maternal mortality rates; compared to white women, those who are Asian, of mixed ethnicity, or black have a higher risk of dying during pregnancy. Similarly in the United States, data from 2014 to 2017 showed that Black, Native American and Alaska Native women were more likely to die during or within a year of pregnancy than women of other racial groups and ethnic.
Studies have investigated underlying systemic causes, such as socioeconomic status. For example, analyzes of data from England from 2015 to 2017 found that 24% of stillbirths, 19% of premature births and 31% of births with fetal growth restriction could be attributed to socio-economic inequalities, and adjusting for factors such as ethnic group significantly reduced these percentages. Outdated government policies can also have long-term effects. In the United States, redlining is a historically discriminatory practice of demarcating areas and basing investment security on the racial makeup of those areas, which negatively impacts people of color. This practice has been associated with poor health outcomes; in areas outlined in red, the rate of premature births is higher in neighborhoods rated as unsafe compared to higher rated neighborhoods, emphasizing the lasting consequences of structural racism.
Digital technologies have been recognized as a potential tool to address racial and ethnic inequalities in health. A partnership between the NHS AI Lab and the Health Foundation is funding four AI-based projects aimed at tackling this problem, such as developing standards to improve the representativeness of health data sets and the use of machine learning to investigate factors contributing to adverse outcomes experienced by mothers. of different ethnic groups. Because implicit biases within healthcare systems can affect the care and treatment received, the Irth app was developed to enable pregnant women of color in the United States to research and write reviews of doctors or hospitals to enable others like them to make more informed choices. know where and from whom to receive care.
Using digital tools can also speed up the implementation of system-wide changes. An example of this is the removal of race and ethnicity variables from a calculator used to estimate the likelihood of a successful vaginal birth after caesarean section (VBAC), which consistently predicts lower chances of success for people of color ; the updated tool has proven to be accurate, and since it is available online, its dissemination and use could potentially occur more quickly and provide fair options for safe delivery.

It is clear that COVID-19 has only served to worsen inequities in maternal health, and addressing this requires a multifaceted approach. Ensuring equitable access to health care and treatment, including COVID-19 vaccines, is imperative to prevent adverse events and eliminate bias in patient-provider interactions. Recognizing and addressing the systemic causes of inequities outside the health system (such as providing better education and employment opportunities) would also help improve health outcomes. Digital health services like telemedicine have proven essential for managing health conditions during the pandemic, but additional investments are needed to increase the availability of these services for underserved and rural communities. It is also essential to collect globally representative data on maternal and perinatal outcomes to lobby for accountability at the government level and drive policy change to ensure a safe, healthy and equitable maternal experience for all.

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DOI: https://doi.org/10.1016/S2589-7500(22)00005-X

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© 2022 The Author(s). Published by Elsevier Ltd.

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Creative Commons Attribution (CC BY 4.0) |

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