Why are black mothers at higher risk of miscarriage?
NeCara McClendon was 19 weeks pregnant and at home on a Tuesday night after work in August 2022 when she started bleeding – profusely.
At the nearest ER in Fredericksburg, Va., where she lives, medical staff told her her cervix was opening. Her baby and the amniotic sac were moving through the birth canal too soon.
A doctor told her there was no hope, a second doctor said she needed an expert consultation, and a third doctor via telehealth recommended a transfer and a technique in which the mother is tilted upside down in a hospital bed to try to avoid a miscarriage.
The mixed messages were disheartening, Mclendon said. “I felt like they kept giving me some hope and then taking it away.”
After the transfer, McClendon discovered that the new hospital did not offer tilt treatment. Instead, they gave him medicine and told him to wait. And she did – for 3 days – before an ultrasound showed her son’s legs in the birth canal.
The doctor said there was nothing to be done. McClendon gave birth to her son the next morning at 19 weeks and 5 days, too young to survive outside her womb.
“The days that followed kept crying – asking [myself] why did this happen to me. I started to feel like a failure.”
Why does it happen
Miscarriages are more common than many people realize. It happens in about 1 of 4 pregnancies, usually in the first trimester. It is often not clear why this happens.
Still, some things increase the risk of miscarriage. Weight is one of them and McClendon is slightly overweight. She also suffers from polycystic ovary syndrome (PCOS), which means her ovaries produce too much male sex hormone called androgens. PCOS can increase the risk of early miscarriage during the first 3 months of pregnancy. (McClendon didn’t lose his son until almost the fifth month.)
But there is another factor: McClendon is black.
In the United States, black women are 43% more likely than white women to miscarry, according to a 2021 study of more than half a million American women. (A black mother is also more likely than a white mother to lose her baby after 20 weeks or during childbirth (stillbirth), or to lose her life, according to the CDC.)
“The scandal is that we really don’t know [why]said the study’s lead author, Siobhan Quenby, MD. “We desperately need more research. It’s not acceptable in 2022 not to know.
Doctors know that risk factors for miscarriage like diabetes, obesity, and high blood pressure are more common in black women than in white women.
But again, the question is why? Factors include differences in biology, society, culture, lifestyle, and medical care, among others. And these can be quite difficult to separate, according to experts.
Other less studied biological factors may also play a role. For example, fibroids – muscle tumors that grow on the lining of the uterus – can sometimes cause miscarriage. Nearly 25% of black women between the ages of 18 and 30 have it, compared to 6% of white women. Black women are also two to three times more likely to have recurring fibroids or complications, which could make the problem worse.
The difference in vaginal microbiota between black and white women may be implicated since the vaginal microbiome has been linked to recurrent miscarriages.
But it’s the gaps in access to and use of medical care that could make the biggest difference, said Ana Langer, MD, director of the Women’s Health Initiative at Harvard’s TH Chan School of Public Health.
Black women are less likely to seek adequate prenatal care for a number of reasons, Langer said. These can include lack of insurance, lack of financial and educational resources, lack of nearby health facilities, fear of abuse, etc. Even the perception of racial discrimination in mainstream society can delay prenatal care, some research has found.
The effect of race in medical settings can be difficult to unpack. In a striking study, the death rate of black newborns, which is three times higher than that of white newborns in the United States, was cut in half when cared for by a black doctor. But surprisingly, the doctors’ race did not affect the mother’s results, according to the study. Researchers continue to study these questions.
After the miscarriage
Since August, McClendon and her partner have been trying to find an in-person grief counselor they could see as a couple. But so far they have been unlucky. So they made their way on their own – with some success. “I won’t say it gets better, but you handle it better,” she said.
Grief comes in waves, she says. Some days everything is fine and other days the pain comes back unexpectedly. The approach of the baby’s due date was particularly difficult.
“Last Saturday was supposed to be my baby shower date,” McClendon said. A day meant to celebrate McClendon and her future son turned into a day to remember what she had lost. It was a tough day. But she got away with it. “It started out sad, but eventually got better,” she said.
