Fetal Mortality

Significance of Fetal Mortality In the United States
Fetal death is defined as the spontaneous intrauterine death of a fetus at any time during pregnancy (CDC, 2022) . Although commonly dismissed as a problem only significant in developing countries, fetal deaths are still common in the United States. Annually, 1 million fetal deaths are occuring at any gestational age in the United States, including almost 26,000 at 20 weeks of gestation or more (MacDorman & Kirmeyer, 2009). The infant mortality rate (IMR) has decreased from 9.2 per 1000 live births in 1980-1990 to 6.7 in 2005-200 (Rossen & Schoendorf, 2014). Despite the overall improvement in fetal survival in the United States, there was a significant increase in relative disparities in preterm IMRs over the past 20 years (Rossen & Schoendorf, 2014). Fetal mortality is emblematic of the population’s health and the quality of care received before and after the baby’s birth (Valenzuela et al., 2022). Despite the overall decrease in fetal mortality in the United States, significant disparities persist between Non-Hispanic black women and Non-Hispanic white women in pregnancy outcomes (Pruitt et al., 2020). According to the CDC, From 2015-2017, the fetal mortality rate for non-Hispanic Black women was more than twice that of non-Hispanic white women (Pruitt et al., 2020). Fetal mortality and maternal health complications are interrelated, involving similar trends among the racial groups affected. Understanding the maternal risk factors and the environmental factors that can be attributed to such disparities in pregnancy outcomes is essential to preventing fetal death in disproportionately affected populations.
Black women experience increases in maternal risk factors and pregnancy complications. Evidence suggests that fetal mortality rates can be attributed to maternal pregnancy complications, including the syndrome of an infant of a diabetic mother and neonatal diabetes mellitus (Pruitt et al., 2020). These conditions are seen to increase among black and Hispanic women compared to white women (Pruitt et al., 2020). Complications of the fetal placenta, cord, and membrane causing fetal death, along with fetal death due to an unknown cause, are also seen to increase among black women compared to white women (Pruitt et al., 2020). Compared to White women, black mothers also have elevated fetal death rates resulting from conditions including infant syndrome of a diabetic mother and neonatal diabetes Mellitus. (Pruitt et al., 2020).
Maternal obesity and underweight status disproportionally affect black women as a maternal risk factor.
Maternal obesity is associated with an increased risk for pregestational and gestational diabetes mellitus, chronic hypertension, and preeclampsia, which risk fetal survival during pregnancy (Simpson, 2002). Obese Black mothers have an increased risk of neonatal mortality compared to obese white mothers, as shown in a study by Salihu et al. (2008). The study found that the
overall risk of neonatal mortality in obese Black mothers increased with BMI, but the same trend was not observed in obese white mothers (Salihu et al., 2008). The disparities in pregnancy outcomes between Black and white women, which appear to be influenced by similar trends in the classification of obesity, may contribute to the growing gap in neonatal mortality rates. Another study indicates that when the contribution of prepregnancy obesity was removed, the disparity in the risk for stillbirth among non-panic black women and non-Hispanic white women was less significant (Lemon et al., 2016). Studies also indicate that being underweight so disproportionately affects black women, with a 60% excess risk of antepartum and intrapartum stillbirth among African Americans compared to underweight white women (Getahun et al., 2007). The increase in adverse effects stemming from maternal obesity and being underweight during pregnancy for black women may perpetuate the racial disparities in pregnancy outcomes for black and white mothers.
Lack of Access and quality of Healthcare for Black Women
The barriers preventing proper access to and quality of maternal healthcare for black women may contribute to the disparities in overall pregnancy outcomes. Health risk behaviors such as smoking, alcohol consumption, and illegal drug use can risk pregnancy outcomes (Kogan et al., 1994). A 1994 study examining the racial disparities in advice from healthcare providers found that Black women were more likely to report not receiving advice from their prenatal care producers about smoking cessation, alcohol use, and breastfeeding (Kogan et al., 1994). The lack of advice about crucial information regarding a woman’s pregnancy demonstrates a lack of proper healthcare interventions for black women, which could contribute to the increase in adverse pregnancy outcomes among black women. Additional studies involving data from birth certificates issued in the United States in 1990 found that Black women are less likely to receive prenatal care services such as Amniocentesis, ultrasonography, and tocolysis than white women (Brett et al., 1994). An additional study indicates that for a white woman, a negative association is seen between late or no prenatal care for white women and not for black women, suggesting that prenatal care was only seen as preventative of antepartum and intrapartum stillbirth in a white woman (Rowland Hogue & Silver, 2011). Significant differences exist between the quality of prenatal healthcare for pregnant black women and that of pregnant white women, which may be affecting overall birth outcomes for black women.
The negative birth outcomes observed in minority populations in the United States are significant, but their significance is amplified by comparing minority populations to racial counterparts in the United States. According to the CDC, Despite receiving later prenatal care and less adequate access to healthcare, women born outside the 50 states and DC had better birth outcomes than their state-born racial/ethnic counterparts (CDC, 2002). Out of all the racial groups studied, the most significant difference occurred between state-born blacks and those
born outside of the 50 states and DC (CDC, 2002). Despite the booming healthcare and economic state of the United States, birth outcomes for racial minorities living outside of the United States had better results. This concerns how well our healthcare resources in the United States are implemented to establish preventative measures to decrease the occurrence of pregnancy complications and failure.
The determinant of low socioeconomic status as a risk factor for infant mortality is also seen to be more significant for Black women than Hispanic Immigrant populations (Hummer et al., 2007). Infants born to Mexican American women in the US have mortality rates comparable to those of infants born to non-Hispanic white women during their first weeks of life (Hummer et al., 2007). Despite similar socioeconomic backgrounds, infants born to Mexican American women have better outcomes than non-Hispanic black women (Hummer et al., 2007). The “Hispanic Paradox” offers valuable insight into the health of the U.S. population, highlighting the social and environmental factors that contribute to the protective advantage of hispanic immigrant women over black women with a deep-rooted ancestral history in the U.S. (Franzini et al., 2001).
Combating Disparities
Infant mortality is a major public health issue with racial disparities in the US. Addressing the interplay between maternal risk factors, socioeconomic status, healthcare access, and quality is crucial in reducing the risk of infant death. Implementing effective measures, such as early detection of risk factors and providing accessible and equitable prenatal care, can help mitigate health risks and prevent disproportionate impacts on minority populations. Initiatives such as the ICHRP, launched by Minnesota in 2017, exemplify a state-implemented program that can improve pregnancy care for black women (Deichen Hansen et al., 2021). The ICHRP addresses the Black-White gap in adverse perinatal outcomes by linking women to resources such as doula care, social workers, and community-based care, promoting strong patient-provider relationships (Deichen Hansen et al., 2021). Programs such as The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are beneficial to helping low-income pregnant women receive supplemental food, healthcare referrals, nutrition, and breastfeeding advice to pregnant women (WIC, 2022). The WIC program has been shown to have a protective effect in which non-participants reported less prenatal advice regarding advice on topics such as alcohol, tobacco, and drug use during pregnancy (Kogan et al., 1994). Programs that improve access to proper maternal care and advice can potentially decrease the disparities in birth outcomes stemming from educational and healthcare access disadvantages.

Works Cited
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