It’s something Dr. Jodie Horton, a board-certified OB-GYN based in Washington, D.C. has seen before: a pregnant patient with a history of asthma transferred from another hospital only for internal medicine doctors to be reluctant to take over treatment.
“It’s weird because [some doctors] are terrified of pregnant people.,” says Dr. Horton. “It’s strange. This is a patient who was hospitalized last year for asthma. She came to us with bronchitis which we know can trigger serious asthma symptoms. As OB doctors, we’re able to take care of a range of medical problems but sometimes they are best served under primary care of a specific specialty, especially in a patient that doesn’t have any obstetrical complaints.”
These patients aren’t a rarity. According to the Asthma and Allergy Foundation of America (AAFA), asthma is common during pregnancy and can get much worse. Pregnant women with severe asthma are more likely to experience early labor and delivery, high blood pressure, which can lead to pre-eclampsia, or low birth weight. This can all be dangerous or life-threatening for both mother and child.
The patient sent to Dr. Horton’s hospital, a Black mom in her mid-twenties, became more unstable and was put on oxygen and steroids to help control her breathing. 48 hours later her condition improved, but Dr. Horton says the riskier scenario could have been avoided.
“With the right treatment and care, mom and baby should have a good outcome,” shares Melanie Carver, AAFA’s chief mission officer. “The best way to reduce risks of complications is to keep asthma under control during pregnancy. It’s important your obstetrician, primary care doctor, and asthma specialist work with you as a team to make sure your condition is monitored closely. This way the right treatment adjustments can be made.”
What’s the Risk For Black Moms?
While most pregnant women experience no change or an improvement in asthma symptoms, AAFA notes 30% say their symptoms worsen. Some studies also show asthma complicates about 7% of all pregnancies.
The risk can be even more serious for Black moms. Due to systemic racism, Black women face disproportionate mortality rates for both maternal health and asthma. According to the Centers for Disease Control and Prevention (CDC), Black women in America are at least three times more likely to die from pregnancy-related causes compared to white women. AAFA’s Asthma Disparities in America report includes a jolting reminder more Black women die from asthma compared to any other group in the nation. Moms of color living in urban areas are often at greatest risk from environmental pollutants which can increase the likelihood of their children developing asthma in utero.
Due to systemic racism, Black women face disproportionate mortality rates for both maternal health and asthma.
Dr. Horton says racial bias could have played a role in her patient’s medical journey, but she can’t be certain. Often equivocated with a feeling, bias is difficult to measure, especially when implicit. What she does know is the grim statistics on outcomes scream what is unspoken. Like with all things medical where numbers are used to course-correct treatment, disparities need to be factored in when caring for Black women.
“Black women have an even tougher time being heard when they say they have an issue. Our symptoms are largely ignored. Then we become so used to dealing with symptoms on our own, no one takes them seriously,” shares Horton.
On top of arming women with basic tools to help manage care, advocates at AAFA are focused on structural change directed at improving outcomes and promoting health equity for Black women and those in other minority groups who are at highest risk for pregnancy complications. That’s why the organization is backing legislative action like the Black Maternal Health Momnibus of 2021 which puts direct resources into solving the health crisis.
AAFA is also developing a new asthma support network for Black women and working with partners on additional programming to help put an end to tragic disparities in both asthma and pregnancy. .
Kafi Drexel Brown is the Public Relations Director for the Asthma and Allergy Foundation of America (AAFA). As an award-winning local television journalist recognized in the field of public health, she’s a NY1 News veteran and former News 12 Networks anchor. She’s also been a regular contributor to major, national health and wellness outlets.