Columbia University, New York, New York, USA.
Stanford University, Stanford, California, USA.
Curr Opin Anaesthesiol. 2022 Jun 1;35(3):278-284. doi: 10.1097/ACO.0000000000001142.
A renewed focus on U.S. racial and ethnic maternal health disparities has arisen following high-profile incidents of police violence and antiracism protests which coincided with the coronavirus disease 2019 pandemic, which has exerted a disproportionate effect on minority communities. Understanding the causes of disparities is pivotal for developing solutions.
Social determinants of health must be addressed during clinical care; however, race must be used with caution in clinical decision-making. Medicaid expansion has been associated with a decrease in severe maternal morbidity and mortality, especially for racial and ethnic minority women. Indirect obstetric causes are the leading cause of maternal death.
Policy-level changes and investment in marginalized communities are required to improve access to quality maternity care at all stages, including preconception, interconception, prenatal, intrapartum and postpartum for 12 months after delivery. Improvements in hospital quality and implementation of evidence-based bundles of care are crucial. Clinicians should receive training regarding susceptibility to implicit bias. To support the research agenda, better collection of race and ethnicity data and anesthesia care indicators is a priority (see Video, Supplemental Digital Content 1 {Video abstract that provides an overview of the causes racial and ethnic disparities in maternal health outcomes.} http://links.lww.com/COAN/A85).
目的综述：在美国，警察暴力和反种族主义抗议活动的关注度日益提高，同时又恰逢 2019 年冠状病毒病大流行，这对少数族裔社区产生了不成比例的影响，种族和民族孕产妇健康差距问题再次受到关注。了解造成差异的原因对于制定解决方案至关重要。
最新发现：在临床护理中必须解决健康的社会决定因素；但是，在临床决策中使用种族时必须谨慎。医疗补助计划的扩大与严重孕产妇发病率和死亡率的降低有关，尤其是对于种族和民族少数群体的妇女。间接产科原因是孕产妇死亡的主要原因。
总结：需要在政策层面进行变革和投资，以改善所有阶段的优质产妇护理的可及性，包括受孕前、受孕间、产前、分娩中和产后 12 个月。改善医院质量和实施循证护理包至关重要。临床医生应接受有关易受隐性偏见影响的培训。为了支持研究议程，更好地收集种族和族裔数据以及麻醉护理指标是当务之急（见视频，补充数字内容 1{提供孕产妇健康结果种族和族裔差异原因概述的视频摘要} http://links.lww.com/COAN/A85）。
