Research Aims to Improve Maternal Health Equity

Cedars-Sinaiactively measures and studies racial and ethnic disparities in maternal healthcare and implements patient-centered projects to resolve any disparities that may arise. Through systemwide shifts and targeted interventions, our OB-GYN leaders are committed to ensuring that all of the healthcare system's 6,500 deliveries per year are as safe and healthy as possible.

Birth equity-uniformly excellent outcomes-can be best achieved by democratizing care, said Kimberly Gregory, MD, MPH, director of Maternal-Fetal Medicine, and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology.

"The more standardized the care is, the less opportunity there is for error and discrepancies," said Gregory, who also holds the Helping Hand of Los Angeles-The Miriam Jacobs Chair in Maternal-Fetal Medicine. "When everyone is treated the same, outcomes are more optimized, with less person-to-person variation."

Newsroom: Cedars-Sinai Joins Community Partners to Reduce Black Maternal Health Gap

Artificial Intelligence to Strengthen Standards

Cedars-Sinaihas leveraged AI to improve cesarean section rates, alert physicians when a patient could benefit from treatment to prevent preeclampsia, and predict postpartum hemorrhage so that clinicians can better intervene.

Now, physicians hope to consider AI's efficacy in helping women control gestational diabetes-a condition that impacts Latin American women at a higher rate than Black and white women-said maternal-fetal medicine specialist and assistant professor of Obstetrics and Gynecology Melissa Wong, MD. AI will monitor blood sugar readings and flag the most complicated patients for immediate attention from a highly skilled educator or nurse, Wong said.

Melissa S. Wong, MD, MHDS

"One of the central ideas in creating AI to solve problems is to be more efficient, and we also aim to bring the patient front and center and prioritize that human aspect of medicine," she said.

Wong also hopes to create AI tools to help women determine their risk for preeclampsia and to empower patients to initiate early pregnancy or preconception care sooner. Black women are less likely than women from other races to have access to OB-GYN care in their first trimester. Increasing early visits and treatment would have positive downstream effects, Wong said, as Black women are three times more likely than white women to die of pregnancy-related complications.

"Inequities that exist before pregnancy feed forward to create all of the later issues," she said. "When women die because of cardiovascular morbidity at the end of pregnancy, they didn't get the illness yesterday-it went undiagnosed. Preconception and early pregnancy care is a huge space where we can reduce inequities in care."

Read: Machine Learning Model Predicts Birth Method

A Mobile Health App for Mental Health

Though Black women are twice as likely as white women to develop perinatal mood and anxiety disorders (PMADs), such as postpartum depression, they're less likely to seek mental health treatment. Black patients report worse communications with their white physicians, which may be why they're also more likely to decline therapy or medication, said Eynav Accortt, PhD, director of the Reproductive Psychology Program and associate professor of Obstetrics and Gynecology.

Accortt is studying whether the use of a mobile health app improves psychological symptoms and birth outcomes and limits participants' experiences of discrimination in medical settings.

Eynav E. Accortt, PhD

The Resources, Inspiration, Support, Empowerment (R.I.S.E.) for Black Maternal Mental Health trial, funded by the National Institutes of Health, aims to recruit 150 pregnant Black women throughout the United States. Half of the participants will be asked to interact with an app that offers culturally sensitive interventions to help women identify symptoms of depression, anxiety and stress and equip them to talk with their family, friends and providers about their mental health. The others will receive basic education around PMADs, a practice previously found to be effective for pregnant women of all races.

"The reality is that the standard of care in this country results in women receiving little or no education or support around their mental health and pregnancy," Accortt said. "This is a real gap in care we need to bridge: We have a group of individuals who are at higher risk for PMADs but also much less likely to initiate care. We need to identify these patients, refer them to help, and follow up to ensure they're gaining self-efficacy and the professional help they need."

Immediate actions to reconcile these needs are only part of larger efforts to improve disparities.

"This isn't the solution; this is just one piece of a very complex puzzle," Accortt said. "We need to reduce medical discrimination and racism. A mobile health app isn't going to help with that, but it's something we can do today."

Read: New Tool Helps Doctors Reduce Patients' Preeclampsia Risk

Data-Determined Improvements

Cedars-Sinai's OB-GYN administrators collect and regularly monitor perinatal and maternal outcomes by race and ethnicity to swiftly identify and address disparities.

"We want to make sure that when patients come here, they're getting the same care no matter what," said Naomi Greene, PhD, an epidemiologist and research assistant professor of Obstetrics and Gynecology.

The team has documented disparities in the rate of successful vaginal births after cesarean sections. Black patients attempting to deliver vaginally after a prior cesarean section were less likely than women of other ethnicities to succeed with a vaginal birth. After midwives were leveraged to provide extra support for every patient, success rates equalized across races.

Other projects monitor interventions to improve breastfeeding rates across racial and ethnic groups, peripartum pain assessment and management, and timely treatment of hypertensive patients during their delivery admission.

For more than 10 years,Gregory has led the Maternal Quality Indicators Work Group, where she developed a childbirth experience survey piloted at 16 hospitals across the region. It is currently distributed at four hospitals, including Cedars-Sinai. The group collects actionable patient-reported outcomes to identify collective opportunities and strengths in maternity care.

Some areas recently identified for improvement are rates of skin-to-skin contact, efforts to honor individuals' birth and breastfeeding plans, more attention for a mother's support person, and more communication regarding progress in labor.

Gregory emphasized that the work aims to ensure equally safe and respectful treatment for all.

"In collecting data on race and ethnicity, we're finding opportunity for improvement with everyone equally," she said.