Health of Minority Women and their Babies

The findings of several studies on the reproductive health status of minority women in the US have been summarized in a series of reports by the Agency for Health Care Quality and Research (AHQR). Excerpts are presented here.

Low Birthweight

The AHCPR's 1992-1997 Patient Outcomes Research Team (PORT) project focused on low birthweight (LBW) in minority and high-risk women. Nearly 70% of all infant mortality and approximately one-third of all handicapping conditions are associated with LBW (less than 2,500 grams, or about 5.2 pounds). Minority women, particularly black women, are at relatively high risk for giving birth to LBW infants, both prematurely and at term.

Minority women are less likely than white women to receive maternal corticosteroids. Bronstein, Cliver, and Goldenberg, Health Services Research 32(6), pp. 825-839, 1998.
In a recent study of the use of tocolysis and corticosteroid therapy to treat premature labor, black women were one-third less likely and Latino women were nearly 100% less likely to receive corticosteroid therapy than white women in similar clinical situations. There were no differences by race in the use of tocolysis.

Higher rates of vaginal infections in black women may contribute to their increased risk of preterm birth. Goldenberg, Klebanoff, Nugent, et al., American Journal of Obstetrics and Gynecology 174(5), pp. 1618-1621, 1996.
This multivariate analysis shows that black women are two to six times more likely than white women to have vaginal infections that are associated with preterm births. Percentages of infection for black and white women in this study included Chlamydia trachomatis (16% and 5%); Neisseria gonorrhoeae (2.5% and 0.4%); Bacteroides (25% and 14%); and bacterial vaginosis (23% and 9%). Infection rates in Hispanic women were higher than in white and Asian women but lower than in black women. Asian women had the lowest rates of vaginal infections.

According to the authors, differences in socioeconomic and health status, medical conditions, health behaviors, and psychological characteristics do not explain the disparity in pregnancy outcomes between black and other women.

Mother's race and insurance status affect infant's access to neonatal intensive care. Bronstein, Capilouto, Carlo, et al., American Journal of Public Health 85(3), pp. 357-361, 1995.
In this study, minority women who had early prenatal care were most likely to have their very low birthweight infants born in hospitals with neonatal intensive care units (NICUs). Also, minority and white women who began prenatal care during the first 3 months of pregnancy were more likely than those who began prenatal care later to be transferred during labor to hospitals with NICUs. Medicaid coverage increased the likelihood of a transfer before delivery, but maternal transfer rates for white women without Medicaid coverage were low.

The authors conclude that some hospitals may retain privately insured women for high-risk deliveries but refer less-well-insured women to subspecialty regional centers.

Other Research on Maternal Health and Low Birthweight

Foreign-born Hispanic women have fewer low birthweight babies than American-born Hispanic women. Fuentes-Afflick, Hessol, and Perez-Stable, Archives of Pediatric and Adolescent Medicine 152, pp. 1105-1112, 1998.
The researchers used 1992 California birth certificate data on nearly 500,000 infants born to Asian, black, Hispanic, and white women to measure the relationship between maternal birthplace, ethnicity, and LBW infants.

There was no difference in LBW infants among foreign-born Asian women and those born in the United States. Likewise, there was no difference in very low or moderately low birthweight infants between foreign-born and American-born black women and white women, after adjustments were made for maternal and infant factors that affect birthweight. Yet Hispanic women born in the United States were more likely than those born in other countries to have moderately LBW infants. The reason for this disparity remains a mystery, according to the researchers.

Asian ethnicity and national origin impact infants' birthweight. Fuentes-Afflick and Hessol, American Journal of Epidemiology 145(2), pp. 148-155, 1997.
Researchers analyzed the relationship between Asian ethnicity/national origin and low birthweight infants among 50,044 Asian and 221,866 white women. They found that LBW rates among Chinese, Korean, and Vietnamese women ranged from 3.5% to 4.7%. LBW rates among Cambodian, Filipino, Indian, Japanese, Laotian, and Thai women ranged from 5.3% to 8.0%.

The relative risk of very LBW was significantly elevated among Filipino women relative to white women, although the absolute difference in incidence was only 0.3%. Asian Indian women were almost twice as likely to have moderately LBW infants as white women.

Low-income women from diverse backgrounds share prenatal care values. Handler, Raube, Kelley, and Giachello, Birth 23(1), pp. 31-37, 1996.
Researchers convened 8 focus groups made up of 50 low-income Mexican-American, Puerto Rican, black, and white women and found that the women valued similar qualities in prenatal care.

Above all, the women wanted providers who communicated with and respected them and were technically competent. They valued continuity of care with the same provider, a clean and friendly setting, short waiting times, and sufficient time with their providers. Nearly all of the women thought it was very important that their caregivers explain what they were doing and answer all of their questions. The women also expressed concerns about the training and communication skills of foreign-trained or foreign caregivers.

Pregnant black women are more likely than other women to have hypertension. Samadi, Mayberry, Zaidi, et al., Obstetrics and Gynecology 87(4), pp. 557-563, 199.
Researchers found that the incidence of pregnancy-induced hypertension was 38.2 per 1,000 deliveries among all U.S. women who delivered babies in a hospital during the period 1988 to 1992. Black women accounted for 18% of all 628,933 deliveries in which the mothers were hypertensive. The incidence of hypertension among black women was 64.2 per 1,000 deliveries compared with 48.6 per 1,000 deliveries for other women. The rate of chronic hypertension preceding pregnancy was about 2.5 times higher among black women (25 per 1,000 deliveries) compared with other women (10.5 per 1,000 deliveries).

Hysterectomy

Researchers profile black and white women undergoing hysterectomy. Kjerulff, Langenberg, Seidman, et al., Journal of Reproductive Medicine 41, pp. 483-490, 1996.
Researchers found that of 409 black women and 836 white women who underwent hysterectomy for noncancerous conditions, 89% of black women and 59% of white women were found to have fibroid tumors. Black women were more likely than white women to have seven or more fibroids (57 vs. 36%); to be anemic (56 vs. 38%); and to have severe pelvic pain (59 vs. 41%).

Black women were diagnosed with fibroids on average at an earlier age (38 vs. 42 years) and underwent hysterectomy at a younger age (42 vs. 45 years). Among women with fibroids undergoing hysterectomy, the average uterine weight for black and white women was 421 and 319 grams, respectively.

Minority women are more likely than white women to experience complications from hysterectomy . Kjerulff, Guzinski, Langenberg, et al., Obstetrics and Gynecology 82(5), pp. 757-764, 1993.
This study found that black women had a 40% greater risk of infection or hemorrhage from hysterectomy than white women. An analysis of the indications and outcomes of more than 53,000 hysterectomy hospitalizations yielded other differences. Black women are more likely than white women to be younger (42 vs. 46 years of age) when undergoing the procedure; they also are more apt than white women to have an abdominal hysterectomy instead of a less invasive vaginal procedure; and they are more than twice as likely as white women to be diagnosed with uterine fibroids. Finally, black women are more likely to be insured by Medicaid or a managed care plan.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.