More disability, fewer resources in pregnant Black, Hispanic patients

In the U.S., pregnant people with multiple sclerosis (MS) who are Black or Hispanic tend to have more severe disability than their white counterparts, along with fewer socioeconomic resources, a new study indicates. 

“What we are seeing is that underrepresented women with MS start their pregnancies with higher disability and fewer health care resources,” Riley Bove, MD, a co-author of the study at the University of California, San Francisco, said in a university press release. “Our findings highlight the importance of considering race-ethnicity and disability in women with MS. They also suggest that socioeconomic opportunity, rather than MS-related care, may lay the foundation for disparities in MS outcomes.”

The study, “Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With Multiple Sclerosis,” was published in Neurology. 

A wealth of data has shown there are substantial disparities in healthcare outcomes across race and ethnic groups in the U.S. Previous studies have shown racial and ethnic disparities in care for MS, as well as healthcare related to pregnancy in the general population. 

There’s been little research into how race and ethnicity influence outcomes for pregnancy care among people with MS, leading the scientists to analyze data collected from nine centers across the U.S. on 294 MS patients who had a pregnancy that resulted in a live birth. Among the patients, 146 were identified as white, 81 as Black, and 67 as Hispanic. Thirteen patients who self-identified as both Black and Hispanic were categorized as Black. 

Based on analyses of ZIP codes, white patients tended to live in more socioeconomically privileged neighborhoods than Black or Hispanic patients. White patients were more likely to be employed or college-educated, and more likely to have private health insurance. 

“We found that Black and Hispanic women faced socioeconomic disadvantages that were likely to have an adverse effect on their health. At the time of conception, they were more likely to live in under-resourced neighborhoods, to be unemployed, and less likely to have private health insurance,” Bove said. 

White patients also tended to be older at conception. On average, white patients were 34 years of age, while Black and Hispanic patients were 31 and 30. 

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Higher EDSS score, lower ultrasound rates

At conception, the median score on the Expanded Disability Status Scale (EDSS) was 1 for white patients cand 1.5 for those from other backgrounds. In other words, although most patients had fairly mild disability overall, white patients tended to be less disabled when they became pregnant, even though they were also older on average. 

“Black and Hispanic women entered pregnancy with less opportunities and greater MS-related inflammatory activity and disability than white women,” the researchers said. 

Ultrasound rates at 14 weeks of pregnancy were significantly higher in white patients (98.6% vs. 93.9%), but pregnancy-related complications like preeclampsia and gestational diabetes occurred at comparable rates in all the ethnic/racial backgrounds. 

“We found that Black and Hispanic women were less likely to receive recommended prenatal care in the form of a 14-week ultrasound,” the researchers wrote, adding the finding is “consistent with the national trend of Black and Hispanic women being less likely to receive prenatal care compared with white women.” 

Black patients had higher rates of emergency C-sections, which is also consistent with national trends.

Use of DMTs comparable

The number of patients treated with disease-modifying therapies for MS during pregnancy was comparable among the groups. Some outcomes indicated Black and Hispanic patients tended to have more disease activity. For example, they had somewhat higher relapse rates, but these differences weren’t generally statistically significant. 

The fact that rates of MS care were similar suggests “that socioeconomic opportunity, rather than MS-related care, may lay the foundation for disparities in MS outcomes,” Bove said. 

“Some reasons for these disparities include transportation, social support, insurance plans, childcare access for existing children, and availability of and access to prenatal appointments,” the researchers wrote. 

Regarding outcomes for babies, infants born to white patients had slightly higher birth weights on average, but the number of babies with an abnormally low birth weight wasn’t significantly different. Rates of breastfeeding also were similar in all three groups, though the median time spent breastfeeding was longer for white patients than Black or Hispanic patients (6 vs.4.5 months). 

“To attenuate some of the disparities identified in the current analyses, collaborative care models may help to increase and optimize access to quality prenatal and neurologic care,” the researchers said.