Why Do Black Women Experience More Pregnancy Loss?

Research has shown that African American women experience all types of pregnancy loss more often than white women. This includes miscarriage as well as stillbirth, preterm birth, and infant death.

The reasons why have baffled scientists for decades. We do understand that black women have higher rates of the risk factors associated with pregnancy loss, such as diabetes, tobacco use, obesity, and low socioeconomic status. But even studies that control for these variables find higher rates of pregnancy loss among African Americans. We also don’t know why African Americans have higher rates of diabetes, high blood pressure, and many other chronic illnesses. These problems have been studied by researchers in nearly every specialty in medicine.

One of the major contributors to the higher rate of infant death is an increased rate of preterm labor in African American women and in premature birth for their babies. Because prematurity and low birth weight are leading causes of death in infants, it’s logical to conclude that more babies born early will ultimately equate to more infants dying from those factors. However, these facts don’t explain why African American women are so much more likely to go into early labor than white women.

One study out of Virginia Commonwealth University identified a small variation in the gene SERPINH1 in black women. This gene is essential in the production of collagen, which is one of the components of the amniotic sac (bag of waters). This collagen defect is three times more common in African American women than in white women, which may account for some of the incidents of preterm labor among black women. Because the gene was only found in 12% of the population studied, however, the collagen defect can’t be the only contributing factor to pregnancy loss in black women.

Another study sponsored by the National Institutes of Health found African Americans were more than twice as likely to experience late pregnancy loss, including stillbirth. That study attributed the difference to the higher rates of pregnancy complications like diabetes, high blood pressure, premature rupture of membranes, uterine bleeding, placental abnormalities, and problems with the umbilical cord in labor. But once again, we don’t understand why black women experience higher rates of those complications.

While our instinct might be to point to socioeconomic factors, several studies have found that the risk of pregnancy loss is the same, even among educated, affluent black women. In other words, we know the problem exists, and we’d like to fix it, but we remain unsure about what we can do to change it. Programs like Life Course aim to tackle the problem holistically, offering everything from job assistance to transportation to prenatal care visits, which have shown some success. Those programs aim mostly at alleviating the socioeconomic factors that contribute to perinatal mortality, but they can’t completely close the gap until we understand what causes the health disparities, even among women who aren’t economically disadvantaged.

There is some speculation that the continuous, low-grade stress caused by racism may be the factor that unifies all African Americans, which may contribute to the increased risk of pregnancy loss. However, there has been no conclusive evidence that stress can cause miscarriage or stillbirth. More research is needed in this area.

In the meantime, there are things African American women can do in an effort to improve their chances of having a healthy pregnancy. The following are some steps they can take:

• Tackle the risk factors you can control
• Don't smoke
• Don’t drink alcohol while you’re pregnant or trying to become pregnant
• Practice safe sex with new partners, and get tested for sexually transmitted infections
• Don’t co-sleep with your baby
• Be as healthy as possible
• Strive for an ideal weight through a healthy diet and active lifestyle
• Get regular medical care, and follow your doctor’s instructions about any chronic health problems you have
• Get prenatal care
• Learn the warning signs of pregnancy loss
• Call your physician if you experience any signs of miscarriage, preterm labor, or decreased fetal movement.

Although some of these statistics related to African American women and pregnancy loss may scare you at first, it's ultimately in your best interest to be informed. Don't be afraid to bring up any potential concerns with your doctor. You may ultimately not have anything to be alarmed about, but it’s always okay to call with questions and concerns.