Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With Multiple Sclerosis: A Diverse Multicenter Cohort
Related Experiment Video
Updated: Jul 5, 2025
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Anne Marie Radzik1, Lilyana Amezcua1, Annika Anderson1
1From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA.
Background And Objectives:
Racial disparities exist in both neurologic and obstetric populations, underscoring the importance of evaluating pregnancy outcomes in diverse women with multiple sclerosis (MS). The objective of this multicenter retrospective study was to compare pregnancy care and outcomes between Black and Hispanic (underrepresented) and White women with MS.
Methods:
Demographic and clinical data were extracted from medical records of 9 US MS centers for women with MS/clinically isolated syndrome who delivered live births between 2010 and 2021. Sites identified at last 15 consecutive Black/Hispanic women and a matching number of White women. Socioeconomic factors, pregnancy, and MS care/outcomes were compared between groups (underrepresented and White and then Black and Hispanic) using Wilcoxon rank sum (U statistic and effect size r reported), χ2, t tests and logistic regressions as appropriate to data type. Multiple imputation by chained equation was used to account for missing data.
Results:
Overall, 294 pregnancies resulting in live births were analyzed ( 81 Black, 67 Hispanic, and 146 White mothers). Relative to underrepresented women, White women lived in areas of higher median (interquartile range [IQR]) Child Opportunity Index (79 [45.8] vs 22 [45.8], U = 3,824, r = 0.56, p < 0.0001) and were more often employed (84.9% vs 75%, odds ratio [OR] 2.57, CI 1.46-4.50, p = 0.0008) and privately insured (93.8% vs 56.8%, OR 11.6, CI 5.5-24.5, p < 0.0001) and more received a 14-week ultrasound (98.6% vs 93.9%, OR 4.66, CI 0.99-21.96, p = 0.027). Mode of delivery was significantly different between the three groups (X2(10,294) = 20.38, p = 0.03); notably, Black women had the highest rates of emergency cesarean deliveries, and Hispanic women highest rates of uncomplicated vaginal deliveries. Babies born to underrepresented women had lower median (IQR) birthweights than babies born to White women (3,198 g [435.3 g] vs 3,275 g [412.5 g], U = 9,255, r = 0.12, p = 0.04) and shorter median (IQR) breastfeeding duration (4.5 [3.3] vs 6.0 [4.2] months, U = 8,184, r = 0.21, p = 0.003). While underrepresented women were younger than White women (mean [SD] 30.9 [4.8] vs 33.8 [4.0], t = 1.97, CI 1.96-3.98, p < 0.0001), their median (Q1-Q3, IQR) Expanded Disability Status Scale was higher (1.5 [1-2.5, 1.5] vs 1 [0-1.5, 1.5], U = 7,260, r = 0.29, p < 0.0001) before pregnancy. Finally, medical records were missing more key data for Black women (19.7% missing vs 8.9% missing, OR 2.54, CI 1.25-5.06, p = 0.008).
Discussion:
In this geographically diverse multicenter cohort, underrepresented women entered pregnancy with higher disability and fewer health care resources. Pregnancy represents a pivotal window where structural factors affect maternal and fetal health and neurologic trajectories; it is a critical period to optimize care and health outcomes.
