Review ArticlesBlack-White disparity in severe cardiovascular maternal morbidity: A systematic review and meta-analysis
Section snippets
Background
Racial disparities in severe cardiovascular maternal morbidity are poorly understood.1,2 Despite improvements in peripartum care, rates of severe morbidity due to cardiac conditions and cerebrovascular accidents in Black women are persistently elevated in comparison to White women.1,2 Maternal cardiovascular complications, including cardiac arrest, stroke, and cardiomyopathy, are top causes of morbidity and mortality,3 especially in Black women.4 A number of studies have shown that Black women
Methods
This systematic review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (registration no. CRD42021256486). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (Supplemental Table 1).6
This study was funded by the Heart and Stroke Foundation of Canada and Fonds de recherche de Québec-Santé. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and
Study selection
We identified 4,752 articles in the literature search and removed 1,291 duplicates (Figure 1). We screened the titles and abstracts of the remaining 3,461 articles for eligibility. We conducted a full text review of 30 articles and found a total of 18 articles that met inclusion criteria. Among included studies, 12 had low risk of bias11-15,17-20,22,24,25 and 6 had moderate risk of bias.8,16,21,26-28 The overall quality of studies was good (median 8 stars, range 4-9 stars) (Supplemental Table
Principal findings
This systematic review and meta-analysis of 18 studies, involving a total of 7.6 million Black and 26.4 million White women, indicates that Black women have nearly double the risk of severe cardiovascular maternal morbidity than White women. Black women have a higher risk of acute myocardial infarction, peripartum cardiomyopathy, and stroke in pregnancy. Disparity between Black and White women was present after adjustment for maternal age, medical comorbidity, socioeconomic status, and other
Author contributions
All the authors have made a significant contribution to this manuscript as follows: UVU conceptualization, methodology, and original drafting of manuscript; XL: second reviewer for studies, result interpretation, manuscript review and editing; SQ: result interpretation, manuscript review; JHP: manuscript review and editing; ND: data curation, manuscript review and editing; NA conceptualization, interpretation of analyses and revising manuscript and editing, and supervision. All the authors have
Funding
This study was funded by the Heart and Stroke Foundation of Canada (G-22-0031974). UV Ukah (302972) and N Auger (296785) were supported by the Fonds de recherche de Québec-Santé. The funders had no involvement in the study design, collection, analysis, and interpretation of data, writing the report, or in the decision to submit article for publication.
Conflict of interest
None.
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Cited by (0)
Declarations of interest: none.