Medically reviewed by Dr. Shani S. Saks, D.O. on August 2, 2023
African-American Women have significantly higher pregnancy complication rates than White women. Maternal mortality rates among AAW are three times higher than for White women due to poor healthcare access, structural and medical racism, and resultant stresses. The presence of inflammatory bowel disease in pregnant African-American women may further increase the risk of adverse pregnancy outcomes.
Inflammatory bowel disease, which primarily involves two autoimmune conditions: Crohn’s disease (CD) and ulcerative colitis (UC), is increasing in the United States. These are chronic conditions. Early studies show that despite lower rates of IBD in Black women, they have worse clinical outcomes.
Further, the influence of IBD on African-American Women (AAW) of childbearing age remains largely unexplored. This is despite the fact that pregnancy-related complications and mortality among AAW are almost three times higher compared to white women. Maternal mortality rates are increasing in the United States, and this is adversely and disproportionately affecting AAW. Higher mortality among AAW due to pregnancy-related complications with or without IBD is due to widespread racism, limited patient knowledge of the healthcare system, and a lack of healthcare access for the population group. It is also due to lower rates of insurance and a lack of inclusiveness.
As a result, AAW are three times more likely to experience severe maternal morbidity. Additionally, the prevalence of IBD among minority communities is increasing. Hence, a better understanding of how IBD could influence pregnancy outcomes in AAW is needed. This study, published in the journal Medical Research Archives, sheds some light on the subject.
African-American Women are more likely to develop pregnancy complications due to health disparities; concurrent IBD may worsen these complications.
AAW are more likely to develop various pregnancy-related complications. They have higher rates of gestational hypertension and fibroids, but medical inequity and lack of access to care are the predominant issues. This results in high maternal mortality rates and infant mortality rates more than twice those of White babies.
A previous study reported that IBD did not significantly impact pre-term delivery, neonatal intensive care unit requirements, or congenital abnormalities in AAW, especially if adequate prenatal care was provided. Nonetheless, this study showed that AAW living with IBD are more likely to have low-birthweight infants. Thus, IBD can contribute to specific adverse outcomes, especially if there are health disparities. Additionally, studies show that although IBD does not seem to influence fertility, it is associated with reduced birth rates.
The Bottom Line
This literature review found that, due to racism and health disparities, AAW have worse pregnancy-related outcomes than White women, and there is a considerable difference between the two racial groups. Additionally, IBD may further worsen pregnancy outcomes in AAW. Hence, the United States needs to create a more inclusive health system. Further, the review found that improving access to insurance policies, such as through Medicaid expansion, can significantly help reduce maternal morbidity in AAW.
Source:
M’Koma, A. E., Ware, J. M., Nabaweesi, R., & Chirwa, S. (2023). Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood. Medical Research Archives, 11(6). https://doi.org/10.18103/mra.v11i6.3784
