Historically, health disparities have disproportionately affected underrepresented people with MS, particularly Black and Latinx females.
About 75% of people diagnosed with multiple sclerosis (MS) are females, and they are typically diagnosed during their reproductive years. Pregnancy opens a critical window for clinicians to optimize prenatal treatments and care that could affect MS outcomes.
Historically, health disparities have disproportionately affected underrepresented people with MS, particularly Black and Latinx females. When compared to their white counterparts, Black and Latinx females experience an earlier onset of MS, have a higher risk for early and overall disability, more extensive neurodegeneration, and a lower overall 5-year survival rate.
To evaluate the differences in prenatal and pregnancy care of Black and Hispanic/Latinx women versus white women with MS, senior author Riley Bove, M.D., from the University of California San Francisco, and his colleagues evaluated medical records from nine MS centers in the U.S. Their results were published in the February issue of Neurology.
The researchers extracted data for women with MS or clinically isolated syndrome who had live births between 2010 and 2021. A total of 294 pregnancies resulted in live births. Bove and his colleagues compared data for Black, Hispanic/Latinx, and white women individually. They also compared Black and Hispanic/Latinx women as a cohort (referred to as underrepresented women) to white women.
Of the 294 pregnancies analyzed, 81 were from Black women, 67 were from Hispanic/Latinx women, and 146 were from white women. Results showed that Black and Hispanic/Latinx women were younger and had higher levels of MS disability upon becoming pregnant compared with white women. White women were also more likely to have private insurance and receive a 14-week ultrasound exam than the underrepresented cohort.
In terms of labor and delivery, Black women had the highest rates of emergency cesarean sections, and Hispanic/Latinx women had the highest rates of uncomplicated vaginal births. Women in the underrepresented cohort had newborns with lower birth weights compared with white women. Within the underrepresented cohort, 9.9 % of Black women delivered babies with low birth weight, and no Hispanic/Latinx women had newborns who fell in this category.
The authors suggest that some reasons for the disparities observed may include access to transportation, social support, types of insurance plans, access to childcare for existing children, and access to prenatal care.
They wrote, “These findings highlight the importance of considering the intersection of race and ethnicity and disability, when evaluating pregnancy outcomes in women with MS. They further suggest that socioeconomic opportunity—perhaps throughout life, rather than specific features of MS-related care, may lay the foundation for disparities in MS outcomes observed in minoritized people in the United States and elsewhere.”
The researchers concluded, “These observations point to several possible approaches to be taken by the field of neurology. To attenuate some of the disparities identified in the current analyses, collaborative care models may help to increase and optimize access to quality prenatal and neurologic care.”