The analysis of nearly 18 years of data found that food insecurity, or the lack of access to healthy foods, was experienced by one in four Black and one in three Hispanic women.

The study by Massachusetts researchers examined social factors influencing blood pressure control by race and ethnicity among U.S. women of childbearing age with high blood pressure.

“Although high blood pressure is a treatable, common chronic health condition, it is a leading cause of pregnancy-related deaths and severe disease,” said senior study author Lara C. Kovell, M.D., a cardiologist at the University of Massachusetts Chan Medical School in Worcester, Massachusetts. “The United States has much higher rates of pregnancy-related deaths than economically similar countries, and Black women are disproportionately affected.”

Previous research has indicated that Black, Hispanic, and Asian women face a higher risk of complications and stroke during childbirth, and Black and Hispanic women who develop pregnancy-induced high blood pressure are at least six times more likely to die than white women.

“A better understanding of racial and ethnic differences in hypertension control may help advance health equity in the United States,” the authors wrote.

In this study, researchers reviewed data from the National Health and Nutrition Examination Survey from 2001 to 2018, which included 1,293 women of child-bearing age, average age 36 years, who had a diagnosis of hypertension with a blood pressure above 140/90 mm Hg or a self-reported history of antihypertensive medication use. About 59% of the participants were white women, 23% were Black women, about 16% were Hispanic women and 1.7% were Asian women. About 20% of the participants had never been pregnant.

Uncontrolled high blood pressure was defined as a systolic blood pressure of 140 mm Hg or higher (the top number in a blood pressure reading) and a diastolic blood pressure of 90 mm Hg or higher (the bottom number). Three consecutive blood pressure measurements were taken after five minutes of seated rest, with one minute in between measures, and the average was calculated. Women answered questions about their lifestyle, such as diet, exercise, smoking and alcohol intake, and access to health care, education and blood pressure medication use.

Social determinants of health factors examined in this study were based on the American Heart Association’s Scientific Statement on Social Determinants of Risk and Outcomes for Cardiovascular Disease. These included education, income, food security, home ownership, language and access to health insurance and medical care.

“Food insecurity is important when thinking about high blood pressure since sodium levels are higher in many lower-cost food options such as canned, ultra-processed and fast foods,” Kovell said. “Moreover, food insecurity and a lack of access to healthy foods have been shown in other studies to increase the risk of high blood pressure.”

Among the researchers’ findings:

Black women of childbearing age with high blood pressure were more than twice as likely to have uncontrolled high blood pressure than white women, and among those who were aware of their diagnosis, Black women were three times more likely to have uncontrolled blood pressure.

The risk factors for high blood pressure persisted among Black women after considering social determinants of health.

Black and Asian women had a higher average blood pressure and were more likely to have uncontrolled high blood pressure than white women; 38% and 36%, respectively, versus 25%.

Food insecurity was higher among Hispanic and Black women compared with white women, 32% and 25%, respectively, versus 13% among white women.

Asian women were more often unaware of their high blood pressure and were more likely to have uncontrolled blood pressure compared with white women.

1 in 4 Black women and one in three Hispanic women reported food insecurity.

Researchers say more study is needed, including examination of structural racism and discrimination, to better understand why Black women of childbearing age face challenges in both food security and heart health.

“Questions about food insecurity and health care access should be included in the standard screening questions at hospital or clinic visits, especially among pregnant women or women planning to become pregnant,” Kovell said. “We still have a lot of work to do to understand and reverse the disparities in maternal mortality between white and Black women in the U.S.”

According to the NIMHD, the researchers collected records for all hospital births in New York City for the period of 2010–2014 from state data. They identified the SMM cases and patients’ race and ethnicity and used data from a state system to determine patients’ insurance coverage. After controlling for risk factors such as age, education level, and whether a mother had previously had a cesarean delivery, the researchers identified the number of SMM cases that each New York City hospital handled during 2010–2014. Finally, they correlated the SMM cases with patients’ racial/ethnic and insurance data.

The researchers found that Black and Latina mothers were more likely to experience SMM than their white counterparts within the same hospital, regardless of how frequently the hospital handled SMM cases. However, the higher SMM risk in Black and Latina women did not depend on the kind of insurance they had.

Other research has shown that one major reason why Black and Latina women have more SMM is that they are more likely to get care at hospitals with worse outcomes for patients overall. However, this research suggests that the problem is more complex. The researchers suggest more studies on topics such as bias by health care providers or problems with communication between patients and health care providers.

The research results were published in Obstetrics and Gynecology.

According to the Centers for Disease Control and Prevention (CDC), approximately 700 women die each year in the United States from pregnancy-related complications. The grants to six institutions are expected to total over $21 million over five years, pending the availability of funds. The project is supported by the National Institute on Minority Health and Health Disparities (NIMHD), the National Heart, Lung, and Blood Institute (NHLBI), and the NIH Office of Research on Women’s Health.

In a news release, the NIH said the research will include original, innovative, and multidisciplinary efforts to advance the understanding, prevention, and reduction of pregnancy-related complications and deaths among disproportionately affected women. This includes women from racial and ethnic minority groups, women with underprivileged socioeconomic status, and those living in underserved rural settings.

The racial disparities in pregnancy-related mortality are stark: respectively, African American and American Indian/Alaska Native women are 3.2 and 2.3 times more likely to die from pregnancy-related causes than are white women. In the case of African American women, the disparity increases with age. Black women under 20 are 1.5 times more likely to die from pregnancy-related causes than are white women in the same age group, but black women ages 30-34 are 4.3 times more likely to die from pregnancy-related causes than are white women ages 30-34. Approximately two thirds of pregnancy-related deaths are preventable, the NIH said, underscoring the need for more research to improve the maternal health outcomes for women before, during, and after delivery.

In addition to maternal deaths, over 25,000 women each year experience severe maternal morbidity (SMM), requiring unexpected short- or long-term life-saving healthcare interventions. Like maternal mortality, SMM has a high rate of preventability. All racial and ethnic minority populations have higher rates of SMM than do white women.

“This initiative is a significant undertaking to reduce preventable causes of maternal deaths,” said NIMHD Director Eliseo J. Pérez-Stable, M.D.  “We need to take a closer look at underlying factors beyond the individual, such as healthcare access, health care settings providing care, community resources, and racial bias and examine how these factors may impact the maternal health outcomes of racial and ethnic minority women.”

In addition to examining factors influencing maternal health disparities, researchers will be among the first to evaluate the effectiveness of a multilevel intervention—at the individual, health care setting, community, and societal levels—to reduce maternal deaths and complications.

The research was conducted using the Boston Birth Cohort.

The study was conducted by Xiaobing Wang, M.D., of the Johns Hopkins University Bloomberg School of Public Health, Baltimore, and colleagues. It was published in JAMA Psychiatry.

Attention deficit/hyperactivity disorder (ADHD) is marked by a pattern of hyperactivity and impulsive behavior. Autism spectrum disorder (ASD) is a complex developmental disorder that affects how a person behaves, interacts with others and learns.

Researchers analyzed data from the Boston Birth Cohort, a long-term study of factors influencing pregnancy and child development. They collected umbilical cord blood from 996 births and measured the amount of acetaminophen and two of its byproducts in each sample. By the time the children were an average of 8.9 years, 25.8% had been diagnosed with ADHD only, 6.6% with ASD only and 4.2% with ADHD and ASD. The researchers classified the amount of acetaminophen and its byproducts in the samples into thirds, from lowest to highest. Compared to the lowest third, the middle third of exposure was associated with about 2.26 times the risk for ADHD. The highest third of exposure was associated with 2.86 times the risk. Similarly, ASD risk was higher for those in the middle third (2.14 times) and highest third (3.62 times).

The authors said that their results support earlier studies linking acetaminophen exposure in the womb with ADHD and ASD. The conclusion of this most recent study underscores the need for additional research. The federal Food and Drug Administration urges careful consideration before using any pain-relieving medication during pregnancy.

Natural Cycles requires women to take their temperature daily using a basal body thermometer, in the morning immediately upon waking, and to enter the reading into the app, which also tracks a user’s menstrual cycle. Basal body thermometers are more sensitive than regular thermometers and detect a minor rise in temperature, only about half of one degree Fahrenheit, around the time of ovulation. Women using the app for contraception should abstain from sex or use protection (such as a condom) when they see “use protection” displayed on the app, which means they’re more likely to be fertile during those days.

“Consumers are increasingly using digital health technologies to inform their everyday health decisions, and this new app can provide an effective method of contraception if it’s used carefully and correctly,” said Terri Cornelison, M.D., Ph.D., assistant director for the health of women in the FDA’s Center for Devices and Radiological Health. “But women should know that no form of contraception works perfectly, so an unplanned pregnancy could still result from correct usage of this device.”

Clinical studies to evaluate the effectiveness of Natural Cycles for use in contraception involved 15,570 women who used the app for an average of eight months. The app had a “perfect use” failure rate of 1.8 percent, which means 1.8 in 100 women who use the app for one year will become pregnant because they had sexual intercourse on a day when the app predicted they would not be fertile or because their contraceptive method failed when they had intercourse on a fertile day. The app had a “typical use” failure rate of 6.5 percent, which accounted for women sometimes not using the app correctly by, for example, having unprotected intercourse on fertile days.

Natural Cycles should not be used by women who have a medical condition where pregnancy would be associated with a significant risk to the mother or the fetus or those currently using birth control or hormonal treatments that inhibit ovulation. Natural Cycles does not provide protection against sexually transmitted infections.

The FDA granted the marketing authorization for this app to Natural Cycles Nordic AB.