Global inequities in adverse pregnancy outcomes: what can we do?

The Health Equity Leadership & Exchange Network states that "health equity exists when all people, regardless of race, sex, sexual orientation, disability, socioeconomic status, geographic location, or other societal constructs, have fair and just access, opportunity, and resources to achieve their highest potential for health." It is clear from the wide discrepancies in maternal and infant mortalities, by race, ethnicity, location, and social and economic status, that health equity has not been achieved in pregnancy care. Although the most obvious evidence of inequities is in low-resource settings, inequities also exist in high-resource settings.

Addressing Racial Disparities in the Hypertensive Disorders in Pregnancy: A Plan for Action from the Preeclampsia Foundation's Racial Disparities Task Force.

Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal mortality in the United States, with Black women and birthing people disproportionately having higher HDP-related deaths and morbidity. In 2020, the Preeclampsia Foundation formed a national Racial Disparities Task Force (RDTF) to identify key recommendations to address issues of racial disparities related to HDP. Recommendations are centered around the Foundation's three pillars: Community, Healthcare Practice, and Research.

Improving Care Beyond Birth: A Qualitative Study of Postpartum Care After High-Risk Pregnancy.

The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care.

A randomized controlled trial comparing the efficacy of nifedipine and enalapril in the postpartum period.

Background: Postpartum hypertension is a common medical complication of pregnancy and is associated with increased healthcare use, including unplanned interactions with the medical system and readmission, which can add significant stress to both a newly postpartum patient and the medical care delivery system. We currently do not know what the best antihypertensive treatment for postpartum hypertension is and tend to use antihypertensives commonly used during pregnancy. However, the mechanism of action of angiotensin-converting enzyme inhibitors may be well suited for the pathophysiology of hypertension in the postpartum period and may help to provide better control of hypertension and, in turn, decrease healthcare use.

Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care.

Birthing people in the United States, particularly those from marginalized communities, experience an unexpectedly high rate of morbidity and mortality. Optimal postpartum care is an opportunity to address immediate maternal health concerns while providing a connection to further high-value primary care. However, postpartum care in the United States is fragmented and incomplete.

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action.

Background: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care.

Methods: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action.

Cardiovascular Health After Preeclampsia: Patient and Provider Perspective.

Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for risk reduction; and 4) next steps.

Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic.

Purpose We developed a postpartum transition clinic to better support women after hypertensive pregnancy. Description Our program goals were (1) early postpartum hypertension medical management, (2) patient and provider education around CVD risk, (3) transition to primary care provider (PCP) and (4) a sustainable clinical model reimbursed by private and public insurances. We focused on women immediately postpartum in this analysis.

Recognition by Women's Health Care Providers of Long-Term Cardiovascular Disease Risk After Preeclampsia.

Objective: To assess health care providers' knowledge regarding pregnancy outcome as a risk factor for cardiovascular disease and evaluate the variables associated with their responses to questions about routine surveillance for cardiovascular disease.

Methods: A voluntary, anonymous survey of internal medicine and obstetric and gynecologic health care providers at an academic institution. Responses to a case-based and direct inquiry questionnaire were evaluated.

Acute histologic chorioamnionitis at term: nearly always noninfectious.

Background: The link between histologic acute chorioamnionitis and infection is well established in preterm deliveries, but less well-studied in term pregnancies, where infection is much less common.

Methodology/principal Findings: We conducted a secondary analysis among 195 low-risk women with term pregnancies enrolled in a randomized trial. Histologic and microbiologic evaluation of placentas included anaerobic and aerobic cultures (including mycoplasma/ureaplasma species) as well as PCR.

Association of epidural-related fever and noninfectious inflammation in term labor.

Objective: To investigate the role of infection and noninfectious inflammation in epidural analgesia-related fever.

Methods: This was an observational analysis of placental cultures and serum admission and postpartum cytokine levels obtained from 200 women at low risk recruited during the prenatal period.

Results: Women receiving labor epidural analgesia had fever develop more frequently (22.

Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation.

Objective: To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation.

Design: Cohort.

Setting: Multisite group practice in eastern Massachusetts.