TY - JOUR
T1 - Individual- and community-level risk factors for maternal morbidity and mortality among Native American women in the USA
T2 - a systematic review
AU - Celaya, Martín
AU - Zahlan, Alaa I.
AU - Rock, Chelsea
AU - Nathan, Akshay
AU - Acharya, Aishwarya
AU - Madhivanan, Purnima
AU - Ehiri, John
AU - Hu, Chengcheng
AU - Pettygrove, Sydney D.
AU - Nuño, Velia Leybas
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/11/28
Y1 - 2024/11/28
N2 - Introduction and objective Maternal morbidity and mortality (MMM) is a public health concern in the USA, with Native American women experiencing higher rates than non-Hispanic White women. Research on risk factors for MMM among Native American women is limited. This systematic review comprehensively synthesizes and critically appraises the literature on risk factors for MMM experienced by Native American women. Methods and analysis A systematic search was conducted on 10 October 2022 in PubMed, Embase, CINAHL and Scopus for articles published since 2012. Selection criteria included observational studies set in the USA, involving Native American women in the perinatal period, and examining the relationship between risk factors and MMM outcomes. Three reviewers screened and extracted data from the included studies, with risk of bias assessed using the National Institutes of Health Quality Assessment Tools. Data were analysed descriptively. Results 15 studies were included. All studies used administrative databases, with settings, including nationwide (seven studies), statewide (four studies) and Indian reservations (four studies). The majority of studies focused on hypertensive disorders of pregnancy (eight studies) and severe maternal morbidity (SMM) (four studies). 26 risk factors were identified. Key risk factors included Native American race (six studies), rural maternal residency (four studies), overweight/obese body mass index (two studies), maternal age (two studies), nulliparity (two studies) and pre-existing medical conditions (one study). Conclusion This review identified risk factors associated with MMM among Native American women, including rural residency, overweight or obesity and advanced maternal age. However, the findings also reveal a scarcity of research specific to this population, limiting the ability to fully understand these risk factors and develop effective interventions. These results emphasise the need for further research and culturally relevant studies to inform public health and address disparities for Native American women, particularly those in rural areas. PROSPERO registration number CRD42022363405.
AB - Introduction and objective Maternal morbidity and mortality (MMM) is a public health concern in the USA, with Native American women experiencing higher rates than non-Hispanic White women. Research on risk factors for MMM among Native American women is limited. This systematic review comprehensively synthesizes and critically appraises the literature on risk factors for MMM experienced by Native American women. Methods and analysis A systematic search was conducted on 10 October 2022 in PubMed, Embase, CINAHL and Scopus for articles published since 2012. Selection criteria included observational studies set in the USA, involving Native American women in the perinatal period, and examining the relationship between risk factors and MMM outcomes. Three reviewers screened and extracted data from the included studies, with risk of bias assessed using the National Institutes of Health Quality Assessment Tools. Data were analysed descriptively. Results 15 studies were included. All studies used administrative databases, with settings, including nationwide (seven studies), statewide (four studies) and Indian reservations (four studies). The majority of studies focused on hypertensive disorders of pregnancy (eight studies) and severe maternal morbidity (SMM) (four studies). 26 risk factors were identified. Key risk factors included Native American race (six studies), rural maternal residency (four studies), overweight/obese body mass index (two studies), maternal age (two studies), nulliparity (two studies) and pre-existing medical conditions (one study). Conclusion This review identified risk factors associated with MMM among Native American women, including rural residency, overweight or obesity and advanced maternal age. However, the findings also reveal a scarcity of research specific to this population, limiting the ability to fully understand these risk factors and develop effective interventions. These results emphasise the need for further research and culturally relevant studies to inform public health and address disparities for Native American women, particularly those in rural areas. PROSPERO registration number CRD42022363405.
KW - Mortality
KW - OBSTETRICS
KW - PUBLIC HEALTH
KW - Pregnant Women
KW - Risk Factors
KW - Systematic Review
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U2 - 10.1136/bmjopen-2024-088380
DO - 10.1136/bmjopen-2024-088380
M3 - Article
C2 - 39613424
AN - SCOPUS:85211205028
SN - 2044-6055
VL - 14
JO - BMJ open
JF - BMJ open
IS - 11
M1 - e088380
ER -