Racial disparity in pregnancy-related mortality associated with livebirth:Can established risk factors explain it?

The authors conducted a nested case-control study to determine whether the fourfold increased risk of pregnancy-related mortality for US Black women c ompared with White women can be explained by racial differences in sociodem ographic and reproductive factors. Cases were derived from a national surve illance database of pregnancy-related deaths and were restricted to White w omen (n = 840) and Black women (n = 448) whose pregnancies resulted in a li vebirth and who died of a pregnancy-related cause between 1979 and 1986. Co ntrols were derived from national natality data and were randomly selected White women and Black women who delivered live infants and did not die from a pregnancy-related cause (n = 5,437). Simultaneous adjustment for risk fa ctors by using logistic regression did not explain the racial gap in pregna ncy-related mortality. The largest racial disparity occurred among women wi th the lowest risk of pregnancy-related death: those of low to moderate par ity who delivered normal-birth-weight babies (adjusted odds ratio = 3.53, 9 5% confidence interval: 2.9, 4.4). in contrast, no racial disparity was fou nd among women with the highest risk of pregnancy-related death: high-parit y women who delivered low-birth-weight babies. These findings indicate that reproductive health care professionals need to develop strategies to reduc e pregnancy-related deaths among both high- and low-risk Black women.