I’ve heard that African-Americans are at higher risk for miscarriage, stillbirth, and infant death. Is that true, and if so, why?
The reasons why have baffled scientists for decades. We do understand that black women have higher rates of the risk factors associated with pregnancy loss, like diabetes, tobacco use, obesity, and low socioeconomic status. But even studies that control for these variables find higher rates of pregnancy loss among African-Americans. We also don’t know why African-Americans have higher rates of diabetes, high blood pressure, and many other chronic illnesses. The problem has been studied by researchers in nearly every specialty in medicine.
One of the major contributors to the higher rate of infant death is an increased rate of preterm labor and premature birth among blacks. Since prematurity and low-birth weight are leading causes of death in infants, it’s logical that more babies born early will mean more infants dying of those factors. However, these facts don’t explain why African-Americans go into early labor so much more often than whites.
One study, led by Jerome Strauss at the Virginia Commonwealth University, was able to identify a small variation in the gene SERPINH1, which is essential in the production of collagen. Collagen is one of the components of the amniotic sac (bag of waters), and this defect, three times more common in African American women than whites, may account for some of the incidents of preterm labor among black women. Since the gene was only found in 12% of the population studied, however, that can’t be the only contributing factor.
A study sponsored by The National Institutes of Health found African Americans were more than twice as likely to have a late pregnancy loss, including stillbirth. That study, published in 2009, attributed the difference to the higher rates of pregnancy complications like diabetes, high blood pressure, premature rupture of membranes, uterine bleeding, placental abnormalities, and problems with the umbilical cord in labor. Once again, we don’t understand why black women experience higher rates of those complications.
While our instinct might be to point to socio-economic factors, several studies have found that the risk of pregnancy loss is the same, even among educated, affluent black women. In other words, we know the problem exists, and we’d like to fix it, but we remain unsure what to do to change it. Programs like Life Course aim to tackle the problem holistically, offering everything from job assistance to transportation to prenatal care visits, all with some success. Those programs aim mostly at treating the socio-economic factors that contribute to perinatal mortality, but they can’t completely close the gap until we understand what causes the disparity, even among women who aren’t economically disadvantaged.
There is some speculation that the continuous, low-grade stress of racism may be the factor that unifies all African-Americans, and may contribute to the increased risk of pregnancy loss. However, there has been no conclusive evidence that stress can cause miscarriage or stillbirth. More research will be necessary.
So, what is the take home message for African-American women looking to improve their chances of having a healthy pregnancy?
- Control those risk factors you can
- Quit smoking
- Don’t drink alcohol while you’re pregnant, or trying to get pregnant
- Practice safe sex with new partners, and get tested for sexually transmitted infections
- Don’t co-sleep with your baby
- Be as healthy as possible
- Strive for an ideal weight through a healthy diet and active lifestyle
- Get regular medical care, and follow your doctor’s instructions about any chronic health problems you have
- Get prenatal care
- Learn the warning signs of pregnancy loss
Anum, EA, Springel, E.H., Shriver, M.D., Strauss, J.F. "Genetic Contributions to Disparities in Preterm Birth." Pediatric Resident. Jan 2009 65(1): 1-9.
Willinger M, Ko CW, Reddy UM. "Racial Disparities in Stillbirth Risk Across Gestation in the United States." American Journal of Obstetrics and Gynecology. 18 Sep 2009, 201:469, e.1-8.