Honor Black History Month and American Heart Month by Championing Interventions to Improve Outcomes for Black Birthing People

By Nicolina Smith, DO, MBA, MSCR

February's recognition of Black History Month and American Heart Month serves as a poignant reminder of the intersectionality of health disparities and systemic inequities. The heightened risk of hypertensive disorders of pregnancy among Black birthing persons, leading to long-term cardiac consequences, is a concerning issue that demands urgent attention. The regrettable truth is that Black birthing persons are 3.4 times more likely to suffer from a pregnancy-related mortality in comparison to their White counterparts. Among these fatalities, 15.9% are linked to cardiac and coronary conditions, 13.9% to cardiomyopathy, and 9.9% to hypertensive disorders. Additionally, the majority of these deaths happen during the postpartum period.  

Implementation science offers a promising framework for addressing these disparities and improving healthcare outcomes. By systematically studying how to integrate evidence-based interventions into real-world settings, implementation science helps bridge the gap between research findings and clinical practice. 

In the context of pregnancy-related health, this approach can involve developing and implementing tailored interventions aimed at improving prenatal care access, promoting culturally appropriate care, addressing social determinants of health, and enhancing patient-provider communication. These interventions must be grounded in an understanding of the unique challenges and barriers faced by Black birthing persons within the healthcare system. SMFM volunteer leaders have developed a number of resources to support you in implementing these interventions. A selected listing is below. 

With cardiovascular conditions being a leading cause of death in the late postpartum period, a time when many evaluations are performed in an emergency department (ED), helping your ED implement ACOG’s new Cardiovascular disease (CVD) in pregnancy and postpartum ED algorithm  could be life-saving.  

Whether implementing one of SMFM’s quality metrics, helping your ED operationalize the new algorithm, or piloting your own initiative as your institution, community engagement and collaboration are vital components of successful implementation efforts. By involving community stakeholders, including patients, advocates, healthcare providers, and policymakers, in the design and implementation of interventions, we can ensure that solutions are culturally relevant, sustainable, and responsive to the needs of those most affected.  

Additionally, ongoing monitoring and evaluation are essential to assess the effectiveness and impact of interventions, identify areas for improvement, and make necessary adjustments to optimize outcomes over time.  

Ultimately, by leveraging implementation science principles, we can work towards achieving health equity and improving the lives of Black birthing persons and their families, addressing not only the immediate challenges but also the underlying structural factors contributing to disparities in maternal health. 

Relevant SMFM Resources  

Courses 

• Patient Safety Toolbox: Using Quality Improvement and Safety Science to Eliminate Pregnancy-Related Racial and Ethnic health Inequities  

• Critical Care in Obstetrics Online Course 2024: Hypertensive Disease Bundle 

• Critical Care in Obstetrics Online Course 2024: Cardiac Disease Bundle  

Webinars 

• Coming Soon! – MFM Fellow Lecture: Optimal Management of Preeclampsia in the 4th trimester (live on March 20, 2024, with recording available after) 

Podcasts 

• SMFM Podcast: Race in Epidemiologic Research 

• SMFM Podcast: Community-Based Participatory Research 

• SMFM Podcast: MFMs and AIM- Partners in improving Maternal Health- Part 2: Severe Hypertension in Pregnancy  

 Checklists 

• Checklist for postpartum discharge of women with hypertensive disorders 

• Checklists for preeclampsia risk-factor screening to guide recommendations for prophylactic low-dose aspirin 

Quality Metrics 

• Prophylactic low-dose aspirin for preeclampsia prevention—quality metric and opportunities for quality improvement 

• Quality metric for timely postpartum follow-up after severe hypertension 

• A quality metric for evaluating timely treatment of severe hypertension (Learn more by listening to the SMFM podcast featuring manuscript authors.)

 Publications 

• Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation 

• Social determinants of health and obstetric outcomes: A report and recommendations of the workshop of the Society for Maternal-Fetal Medicine 

 Other 

• Consumer Education Campaign: Make Preeclampsia History 

• Infographic: Strategies to Overcome Racism’s Impact on Pregnancy Outcomes 

Nicolina Smith, DO, MBA, MSCR, is a maternal-fetal medicine fellow training at Henry Ford Health in Detroit, MI, and member of SMFM’s Patient Safety & Quality Committee. Dr. Smith is engaged in quality improvement at her institution. Her areas of interest include screening and treating sleep disorders in pregnancy and addressing 4th trimester barriers to care.