Stress from racism and deprivation could explain why black women are more likely to die during childbirth, a study has found. Researchers at the University of Cambridge reviewed 44 existing studies examining three physiological pathways associated with worse pregnancy outcomes: oxidative stress, inflammation, and uteroplacental vascular resistance. They found that black women had higher levels of all three metrics.
These physiological differences are not due to genetic factors, according to the researchers, but rather suggest that socioenvironmental stressors such as systemic racism and deprivation may influence the body's ability to function healthily during pregnancy. The study, published in the journal Trends in Endocrinology and Metabolism, highlights that pregnancy and childbirth put great stress on a woman's body, and black women may experience additional strain from systemic racism, socioeconomic disadvantage, and environmental stressors.
Lead author Grace Amedor said: 'During pregnancy, this strain may affect key biological processes in ways that increase the risk of conditions such as pre-eclampsia. I was surprised that although this disparity had been known for a long time, there was little research into the potential underlying physiological reasons.' She emphasised the importance of tackling root causes such as socioeconomic disparities and systemic racism.
Increased uteroplacental vascular resistance involves tightening of blood vessels, reducing blood flow to the placenta, while higher oxidative stress occurs when reactive oxygen species overwhelm antioxidant defences. High inflammation levels are also linked to worse outcomes. These complications are associated with pre-eclampsia, preterm birth, and foetal growth restrictions.
In the UK, black women are 2.7 times more likely to die during childbirth compared with white women, and are also more likely to experience serious birth complications and perinatal mental health illnesses. Black babies are twice as likely to be stillborn. Senior author Prof Dino Giussani said the disparity has often been explained by differences in medical care or social inequalities, but this study shows exposures can disproportionately affect black women's bodies.
Dr Jenny Barber, vice-president of the Royal College of Obstetricians and Gynaecologists, called the findings important and said ending racial health inequalities requires coordinated cross-government action and sustained investment in maternity services.
