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Objectives. To compare pregnancy-related mortality ratios (PRMRs) associated with COVID-19 by race/ethnicity, by region of residence, and in states with and without Medicaid expansion. Methods. We used 2020–2021 data from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research in our analysis. We stratified PRMRs by race/ethnicity, census regions, and Medicaid expansion and nonexpansion states. Results. The 2020–2021 PRMR was 40.3 per 100 000 live births. American Indian/ Alaska Native pregnant people had the greatest PRMR, followed by non-Hispanic Blacks and non-Hispanic Native Hawaiians/other Pacific Islanders. PRMRs associated with COVID-19 in the southern region were at least 2 times higher than in other regions and were highest for all pregnant people in the various racial/ethnic groups. PRMRs associated with COVID-19 were lower in Medicaid expansion states than in nonexpansion states. Conclusions. The US COVID-19 epidemic exacerbated racial and ethnic disparities in pregnancy-related mortality. Public Health Implications. The alarming increase in disparities among racial and ethnic pregnant people during the COVID-19 pandemic underscores the need to address social determinants of health at the structural level. (Am J Public Health. 2024;114(S9): S723–S730. https://doi.org/10.2105/AJPH.2024.307814) [ABSTRACT FROM AUTHOR]

In the United States, the excess rates of infant mortality, VLBW, and preterm delivery among African American families relative to white families are known as “the gap.” A group of researchers in the Division of Reproductive Health at the Centers for Disease Control and Prevention proposed that the study of causes of the gap in preterm delivery and the potential interventions to eliminate this disparity required a multidisciplinary approach to elucidate the biologic pathways, stressors, and social environment associated with preterm birth. They encouraged studies that examined the social and political impact of being an African American woman in the United States, racism, and the combined effects of gender, racism, and relative social position, as potential unmeasured etiologic factors that contribute to the gap. The studies conducted represent the expertise of anthropologists, sociologists, medical researchers, and epidemiologists who study both individual and social causes and then also provide a theoretical interpretation by those who lived the experience, (e.g., the study participants) rather than just the researchers' interpretation of the causes of and prevention strategies for the gap. [ABSTRACT FROM AUTHOR]