Race Disparities in Pregnancy Care and Clinical Outcomes in Women with MS: a Diverse, Multicenter Cohort
Anne Marie Radzik1, Annika Anderson1, Lilyana Amezcua2, Sophie Ahmad3, Rachel Brandstadter4, Michelle Fabian5, Edith Graham3, Sophia Hodgkinson6, Lindsay Horton7, Dina Jacobs4, Ilana Katz Sand5, Amit Kohli5, Annette Okai8, Monica McLemore1, Jasmin Patel5, Shane Poole1, Sammita Satyanarayan5, Claire Riley9, Lauren Tardo7, Elizabeth Verter5, Veronica Villacorta2, Mitzi Williams10, Vanessa Zimmerman4, Leah Zuroff4, Maria Houtchens6, Riley Bove1
1University of California, San Francisco, 2University of Southern California, 3Northwestern University, 4Hospital of the University of Pennsylvania, 5Corinne Goldsmith Dickinson Center for MS, 6Brigham and Women's Hospital, 7University of Texas Southwestern Medical Center, 8North Texas Institute of Neurology and Headache, 9Columbia University Medical Center, 10Joi Life Wellness Group
Objective:
To compare pregnancy care and outcomes between Black, Hispanic, and White women with MS in a multicenter cohort.
Background:
Racial disparities persist in neurological and obstetrical care. Disparities in MS prevalence and outcomes reported for Black and Hispanic patients underscore the importance of evaluating for possible racial disparities in care during pregnancy.
Design/Methods:
Demographic and clinical data were extracted from the medical records of nine US MS centers for women with CIS/MS who became pregnant from 2010-2021. Each site provided data on similar numbers of Black/Hispanic and White women. Comparisons between racial groups of MS and pregnancy outcomes, socioeconomic factors, and data missingness were performed using Wilcoxon tests, ANOVA’s, and logistic regressions as appropriate to data type.
Results:
Overall, 294 live births were analyzed: 81 Black, 67 Hispanic, and 146 White women. Black and Hispanic women lived in areas of lower Child Opportunity Index (p<0.0001), while White women were more often employed, privately insured, and completed advanced degrees (p=0.003; p<0.0001; p<0.0001). Fewer Black and Hispanic women received a 14wk ultrasound (p=0.001); more Black women had emergency cesarean deliveries (p<0.03). Babies born to Black and Hispanic women had lower birthweights (p=0.04) and breastfed for shorter duration (p=0.004). Black and Hispanic women had higher median EDSS (B/H=1.5 W=1; p<0.0001) and higher annualized relapse rates at all time points (p<0.05 pre-conception). Finally, more Black women had missing medical record data for key metrics (p=0.046).
Conclusions:
In this large multicenter cohort, Black and Hispanic women entered pregnancy with higher disability and less opportunity. Disparities in prenatal care and pregnancy outcomes have the potential to impact pregnancy experience, MS trajectories and intergenerational outcomes. Therefore, pregnancy represents an important opportunity for identifying structural access barriers and optimizing care in the neurological population. Further, inconsistencies in medical record documentation point to current methodological limitations in the study of health disparities.