Curr Diab Rep. 2025 May 14;25(1):33. doi: 10.1007/s11892-025-01587-1.
ABSTRACT
PURPOSE OF REVIEW: The rates of diabetes in pregnancy (type 1, type 2, and gestational diabetes) are increasing. Diabetes in pregnancy is associated with increased risk for maternal and neonatal complications. Certain groups are disproportionately affected by these complications and this paper reviews the data about disparities in diabetes in pregnancy and explores the social determinants of health (SDoH) underlying these disparities.
RECENT FINDINGS: Rates of diagnosis of gestational diabetes and pregestational diabetes are higher in racial and ethnic minority groups and people with socioeconomic disadvantage. There is higher all cause maternal mortality for Black people compared to White people. Emerging data suggests higher risk for adverse pregnancy outcomes for Black, American Indian, and Hispanic/Latina subjects with diabetes compared to White subjects. Individuals living in neighborhoods with higher poverty and less educational attainment also have higher rates of pregnancy and neonatal complications with diabetes. Diabetes in pregnancy is a complex condition which requires specialty care that can be time-consuming and costly. Individuals with disadvantages in income and employment, food security, social protection and support, and access to affordable and quality health services may be particularly susceptible to adverse outcomes of diabetes in pregnancy. Providers can reduce disparities by recognizing individuals with vulnerabilities in SDoH and tailoring treatment to social context. Equitable access to diabetes technology and postpartum care can also reduce disparities in outcomes.
PMID:40366501 | PMC:PMC12078402 | DOI:10.1007/s11892-025-01587-1
Front Public Health. 2025 Apr 15;13:1544903. doi: 10.3389/fpubh.2025.1544903. eCollection 2025.
ABSTRACT
INTRODUCTION: Birmingham and Solihull face significant challenges related to adverse birth outcomes. This study aimed to identify demographic, socioeconomic, and lifestyle factors associated with an increased risk of low birth weight, premature birth, stillbirth, and neonatal death in Birmingham and Solihull.
METHODS: Births (n = 41, 231) between October 2020 and April 2023 were analysed. The attributable fraction of premature births and low birth weight (LBW) attributable to socioeconomic and ethnic inequality was calculated. Multiple logistic regression analyses identified groups that had increased odds of premature birth (n = 3, 312), LBW (n = 1, 197), stillbirth (n = 173), and neonatal death (n = 208).
RESULTS: Attributable fraction analysis estimated that 191 premature births and 211 LBWs each year would not have occurred if all women had the same rates as White women living in the least deprived areas. Ethnicity, socioeconomic deprivation, medical care, lifestyle, and vulnerability status were found to be significant risk factors for adverse birth outcomes. Asian and Black women had 1.4-2.7 times the odds of LBW compared to White women (p < 0.01). Black women had increased odds of stillbirth (OR : 1.75, p = 0.017) and Asian women had increased odds of neonatal death (OR : 1.90, p < 0.001). The odds of LBW (OR : 3.3), premature birth (OR : 27.2), and neonatal death (OR : 5.6) were significantly increased for twins (p < 0.001). For women smoking at delivery, the odds of LBW (OR : 2.3), premature birth (OR : 1.5), and stillbirth (OR : 1.6) were significantly increased (p < 0.05). Deprivation, and/or financial and housing issues also increased the odds of adverse birth outcomes (p < 0.05).
DISCUSSION: These findings underscore the importance of targeted interventions and support for at-risk populations to reduce adverse birth outcomes in vulnerable communities.
PMID:40302778 | PMC:PMC12037573 | DOI:10.3389/fpubh.2025.1544903
Int J Equity Health. 2025 Apr 28;24(1):114. doi: 10.1186/s12939-025-02488-1.
ABSTRACT
Black maternal mortality in the United States remains alarmingly high-Black women are still more than three times as likely to die from pregnancy-related causes than White women. This crisis is not due to individual choices or access alone, but to deeply rooted structural inequities, including systemic racism, policy exclusion, and the neglect of Black-led care models. While efforts like Medicaid expansion and the Black Maternal Health Momnibus Act aim to address these gaps, they often fall short by relying on narrow, one-size-fits-all solutions. This commentary uses Critical Health Equity theory and the Intersectionality-Based Policy Analysis (IBPA) framework to examine how current policies may unintentionally reinforce the very inequities they seek to eliminate. It argues that achieving real equity in maternal health requires more than reform-it calls for a fundamental shift in who holds power, whose knowledge is valued, and how care is delivered. A new framework is proposed that centers Black leadership, supports community-led research, and promotes culturally safe, justice-oriented care.
PMID:40296089 | PMC:PMC12039294 | DOI:10.1186/s12939-025-02488-1
BMC Pregnancy Childbirth. 2025 Apr 26;25(1):507. doi: 10.1186/s12884-025-07624-x.
ABSTRACT
BACKGROUND: Norway is recognised for its high-quality maternal healthcare. However, health equity has yet to be achieved. This study explored the experiences of women with refugee backgrounds during pregnancy, birth, and postpartum in Norway. We aimed to understand how the diversity of their backgrounds and current life circumstances, influenced the women's health, well-being, and interactions with maternal healthcare services. The study focused on the perspectives of women whose needs have not been fully acknowledged in maternal healthcare services both at national and local levels.
METHOD: Consistent with our Feminist Participatory Action Research approach, we included multicultural doulas, women with lived experience of migration and giving birth in Norway, as co-researchers. We also collaborated with practitioners such as midwives and other relevant actors. We recruited and conducted qualitative interviews with ten women with refugee backgrounds who had given birth in Norway.
RESULTS: Our findings revealed that the women's intersecting identities were crucial in shaping their maternal healthcare needs during pregnancy, birth and postpartum. The structural inequities faced in maternal healthcare services during pregnancy such as lack of language and communication support, limited access to social support networks, and unfamiliarity with healthcare services were also apparent during birth and postpartum. Adjusting to a new country while raising children compounded these challenges, impacting experiences of pregnancy, birth, and postpartum.
CONCLUSION: This study highlights the importance of adopting an intersectional approach to maternal healthcare, and not treating race, class, gender and migration experiences in isolation, but taking them into consideration when designing and implementing services. Our results suggest that current policies and services often overlook the specific needs of women with refugee backgrounds. To achieve true health equity in maternal healthcare services, policies should prioritize these women's unique needs and experiences, ensure that services are adapted and properly funded, and that initiatives guarantee active participation and representation from women with refugee backgrounds.
PMID:40287621 | PMC:PMC12032691 | DOI:10.1186/s12884-025-07624-x
Int J Equity Health. 2025 Apr 23;24(1):111. doi: 10.1186/s12939-025-02452-z.
ABSTRACT
BACKGROUND: Circumstances that lead to maternal death are complex and multifactorial, including inequity and racism issues. Quality improvement (QI) strategies have demonstrated success in improving maternal outcomes. The Collaborative Abraço de Mãe (CAM) reduced the institutional maternal mortality rate (iMMR) by 34.2% from the baseline rate in 19 Brazilian maternity hospitals.
OBJECTIVE: To present the integration of anti-racism and equity strategies implemented during the CAM.
METHODS: A QI report assessing the CAM focused on strengthening the awareness of obstetric teams about ethnic-racial inequalities and institutional racism as social determinants of maternal outcomes. A mixed methods approach was used to understand the overall impact of the intervention. Measures included the Anti-Racist Leadership Survey and interviews (individual and grouped). Qualitative and quantitative data were applied simultaneously but independently, followed by a triangulated comparison to define convergences.
RESULTS: The domain with the highest average score was emotional resources and communication; the lowest was fundamental knowledge and translation of the knowledge in action. Interviews evidenced three categories: (A) equity and anti-racism training contributed to a more profound recognition of race and racism awareness, leading to a change in culture; (B) Priority change ideas and actions focusing on anti-racism and equity were demonstrated in several ways among the leaders; and (C) Challenges when equity is centralised in the care model. Triangulations revealed two convergences: (i) Evidence of a better understanding of ethnic-racial inequalities, institutional racism, and racism recognition by the leaders and participating institutions, and (ii) Resistance when trying to bring new content to the clinical staff, as well as a lack of tools when dealing with the emotional resources needed to confront interpersonal racism.
CONCLUSION: With a significant reduction in iMMR, the CAM reveals that a QI intervention addressing inequities and racism issues is a feasible and promising approach to improve maternal outcomes within an equity-oriented model of care.
PMID:40269914 | PMC:PMC12016309 | DOI:10.1186/s12939-025-02452-z