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Black-White disparity in severe cardiovascular maternal morbidity: a systematic review and meta-analysis

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Abstract

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To summarize existing literature on Black-White disparities in the prevalence of severe maternal cardiovascular morbidity.Ìý

Data SourcesÌý

We systematically searched MEDLINE, EMBASE, and CINAHL for studies published before July 31, 2021 that compared the risk of severe maternal cardiovascular morbidity between Black and White women.Ìý

Study Eligibility CriteriaÌý

We included observational cohort, case-control, and cross-sectional studies comparing outcomes between pregnant Black and White patients. The outcome was severe maternal cardiovascular morbidity, including acute myocardial infarction, peripartum cardiomyopathy, and stroke during pregnancy, delivery, or postpartum.Ìý

Study Appraisal And Synthesis MethodsÌý

We extracted relevant information including adjusted and unadjusted effect estimates, and assessed the quality of studies using the Newcastle-Ottawa scale. We used random-effects models to estimate the pooled association between race and severe maternal cardiovascular morbidity, and present results as odds ratios with 95% confidence intervals for the comparison of Black relative to White women.Ìý

ResultsÌý

We included 18 studies that met the eligibility criteria for systematic review and meta-analysis. All studies were conducted in the U.S. and included a total of 7,656,876 Black women and 26,412,600 White women. Risk of bias was low for most included studies. Compared with White women, Black women had an increased risk of any severe maternal cardiovascular morbidity (adjusted odds ratio, 1.90; 95% confidence interval, 1.54-2.33). Black women were at risk of acute myocardial infarction (adjusted odds ratio, 1.38; 95% confidence interval, 1.14-1.68), peripartum cardiomyopathy (adjusted odds ratio, 1.71; 95% confidence interval, 1.51-1.94), and stroke (adjusted odds ratio, 2.13; 95% confidence interval, 1.39-3.26).Ìý

ConclusionÌý

Black women have a considerably higher risk of severe maternal cardiovascular morbidity than White women, including acute myocardial infarction, peripartum cardiomyopathy, and stroke. Reducing inequality in adverse cardiovascular outcomes of pregnancy between Black and White women should be a priority.Ìý

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