Study links racial disparities in severe maternal morbidity largely to preexisting conditions

Researchers at the University of Houston have reported that Black women in Texas experience severe maternal morbidity (SMM) nearly twice as often as white women. This finding highlights a critical need for expanded health care for women well before they are hospitalized for childbirth.

The study, conducted by UH’s Institute for Research on Women, Gender and Sexuality (IRWGS), indicates that preexisting health conditions account for nearly 80% of the Black-white SMM gap. The remaining disparity could be attributed to differences in severity, treatment variations within the same hospital or from the same physician due to biases, among other factors.

“By a large margin, the major contributor to the Black-white severe maternal morbidity gap is the difference in the comorbidity score between non-Hispanic Black and non-Hispanic white women,” states “Racial Disparities in Maternal Health: The Role of Preexisting Health Conditions.”

Annamaria Milazzo, research assistant professor at IRWGS, explained, “Black women exhibit a higher number and different composition of preexistent health conditions compared to white women upon entering the hospital for delivery. The data suggest that a vast portion of the disparity can be explained by differences in health status prior to delivery, and it does not seem to be the result of Black women being more likely to use worse hospitals and/or see worse doctors compared to white women."

While maternal mortality involves death due to pregnancy-related causes, SMM cases are considered near misses for maternal death because they can lead to death if not properly identified and managed. According to the National Institutes of Health’s Office of Research on Women’s Health, approximately 700 women die each year in the U.S. from pregnancy-related causes. Rates of SMM are significantly higher, with roughly 75 cases occurring per every maternal death. Black women experience substantially higher rates of both maternal mortality and SMM.

Milazzo analyzed hospital inpatient discharge data from all deliveries in Texas from 2016 to 2022. Her findings underscore a clear need for more focus on women's health well before conception, which could include expanded access to Medicaid. In Texas, almost one in four reproductive-age women do not have health insurance—the highest share in the nation—and Medicaid only becomes available to many low-income women after they become pregnant.

“Better access to comprehensive care pre-conception, including regular check-ups for improved management of medical conditions as they emerge, as well as improved access to prenatal care could help address these issues,” Milazzo stated.

“Overall, the findings underscore the critical need for prioritizing women's health well before childbirth hospitalization,” according to “Racial Disparities in Maternal Health: The Role of Preexisting Health Conditions.”

The Institute for Research on Women, Gender and Sexuality will host a webinar on Monday, July 8th, from 11 a.m. – 12 p.m., presenting these findings and discussing potential solutions.

What: Webinar on UH IRWGS Maternal Morbidity Report

When: Monday, July 8th

Click here to register for the webinar.