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Intersection trauma

Intersection of Trauma, Race in Pregnancy Calls for More Study

Black patients experienced more moderate to severe violent trauma during pregnancy than did non-Black patients at a single Baltimore institution, according to a small retrospective cohort study presented in a poster at the 2021 virtual meeting of the American College of Obstetricians and Gynecologists. “Trauma is the leading nonobstetric cause of death in pregnant women,”…

Black patients experienced more moderate to acute acute injury during pregnancy than did non-Black patients at a single Baltimore institution, as shown by a tiny retrospective cohort study presented at a poster in the 2021 virtual meeting of the American College of Obstetricians and Gynecologists.

“Trauma is the leading nonobstetric cause of death in pregnant women,” and Black communities are at a greater risk of trauma, Rebecca H. Jessel, MD, of Icahn School of Medicine at Mount Sinai in New York, and partners wrote in their own poster.

The study’s findings raise research questions which need more exploration, based on Neel Shah, MD, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, Boston, and founding director of the Delivery Decisions Initiative at Harvard’s Ariadne Labs.

“This is an interesting study that opens a line of inquiry into how trauma may impact the pregnancies of those who are Black differently,” Shah, who wasn’t involved in the study, said in an interview. “The observed disparity is consistent with the racial inequities in outcomes we see across obstetric outcomes and requires further research into the causes and solutions.”

The investigators retrospectively examined pregnant patients treated between 2015 and 2018 at the University of Maryland’s R Adams Cowley Shock Trauma Center in Baltimore. In addition to maternal demographics, details about the delivery, and perinatal results, the researchers noted if the trauma was violent, such as assault, or nonviolent, such as motor vehicle accidents. Moderate to severe injury was defined as an injury severity score of 9.

Among 3,536 women aged 15-49 treated at the shock trauma center, 62 were pregnant, and 71percent of those women were Black. Nineteen percent were White patients, 5 percent were Asian patients, and 5 percent were of another race/ethnicity. Black patients were, normally, 27 years old at the time of the trauma. Non-Black patients were, normally, 25 years old. The average gestational age at the time of trauma was 25 weeks, 3 days in Black women and 23 weeks, 4 days in non-Black women.

The most common cause of injury was a car collision, implicated in 56% of the injury cases. Assault was the next most common cause of trauma, making up almost a quarter (23%) of cases. The other injuries came from accidents (16%) or inhalation (5 percent ). The average injury severity score was 4.7, with a moderate harm for 76% of patients and a moderate to severe injury in 24%.

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