Date of Graduation

Summer 8-10-2019

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Maternal morbidity and mortality during childbirth has been a tragic complication of childbirth throughout history. However, maternal mortality rates have been trending down in every developed country other than the United States of America. Certain populations and comorbidities present expectant mothers with greater risk for maternal mortality or severe life-threatening complications during childbirth. Many of these factors are medically intuitive such as obesity, tobacco use, hypercoagulabilities/hemoglobinemias, positive family history, various disease states, and pre-partum complications such as preeclampsia. However, the greatest risk factor for maternal mortality in America is being African American. Two main factors were stand out in African American pregnancies and childbirth compared to other ethnicities, these two factors were firstly that African American women tend to give birth to low birthweight (LBW) babies at higher rates than any other race. Secondly, African American women are at higher rates of maternal morbidity and mortality. Since venous thromboembolism accounts for 10% of all maternal deaths these findings prompted us to explore if a link between LBW babies and occurrence of venous thromboembolism is present.

Methods: Exhaustive search of available medical literature was performed via Web of Science, CINAHL, MEDLINE-PubMed, and GoogleScholar using the keywords "low birthweight" OR "birth weight" OR "small for gestational age" OR "intrauterine growth restriction" OR "fetal growth retardation" OR postpartum AND "venous thromboembolism”. Articles were assessed for quality based on GRADE criteria.

Results: African American women were found to be higher risk for postpartum VTE than and other race, and a 50% higher risk than white women. This correlation was particularly prominent when examining rates of postpartum VTE in African American women who has to undergo cesarean section, while cesarean section puts all races at increased risk of VTE, and in this population cesarean section is the largest risk factor for pulmonary embolism. Being an African American woman who underwent a cesarean section increased the VTE risk by 5 times compared to white women who underwent a cesarean section.

Conclusion: Low birth weight babies increase the risk of venous thromboembolism in mothers, leading to higher maternal death. Research has already explored what could be causing this discrepancy, with one of the leading theories causing LBW being exposure to chronic stress. One study found that chronic exposure to racism throughout one’s life has a “dose dependent response” to low birth weight. In other words, the longer an expectant mother has been exposed to racism, the more likely the baby is going to be born into the very low birth weight (VLBW) category.

The medical community needs to continue to explore what is causing the increased maternal mortality in the African American community. With the above proposed assessment, we suggest that mothers who birth low birthweight babies – particularly African American women – be closely monitored for VTE. Further research may consider specific protocols to address this complication and therefore reduce maternal mortality rates. Optimally, research would be conducted to determine the etiologies of low birthweight babies in African American women so that this can be addressed and prevented – therefore, saving thousands of lives.

Keywords: low birthweight, postpartum, venous thromboembolism, African American

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