在西班牙裔女性的孕产妇死亡率激增之后，人们开始寻找答案

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2019冠状病毒病大流行带来了不少令人沮丧的统计数据. 但 for people who care about women's health, one number about Hispanic women stood out.

2020年，这些国家的孕产妇死亡率大幅上升，比前一年上升了44%, 根据最新的数据 疾病控制和预防中心. 每10万名新生儿中就有18名.西班牙裔女性死亡人数从12人上升到2人.6 in 2019. 40岁及以上的女性患病风险最高.

The increase drew attention in part because Hispanic women's maternal mortality rate had been relatively low when compared with white and Black women.

Dr. Sadiya汗, an assistant professor of medicine in the division of cardiology at Northwestern University's Feinberg School of Medicine in Chicago, 他说，现在要知道价格上涨背后的原因还为时过早. 但汗, who has written or co-written several studies related to pregnancy and heart health, 将2020年之前普遍存在的卫生不平等比作柴火. “大流行引发了这种情况."

美国妇女死于分娩相关原因的问题并不新鲜, 也不是西班牙裔女性的专利. 有充分证据表明，白人和黑人女性之间的差距在2020年也有所扩大. 6月，在发行一份 白宫报告 on the topic, Vice President Kamala Harris labeled maternal mortality a national crisis.

根据美国疾病控制与预防中心的数据，861名美国人.S. 2020年，女性死于产妇原因, even though maternal mortality – usually defined as deaths during pregnancy or within 42 days after pregnancy – is considered largely preventable.

大多数产妇死亡源于心血管问题. 疾病预防控制中心2016年至2018年的数据显示，这些疾病包括血栓, 心肌病(心肌衰弱), cerebrovascular accidents (strokes) and blood pressure-related conditions such as preeclampsia.

根据疾控中心, more pregnant people are experiencing chronic health conditions such as high blood pressure, diabetes and chronic heart disease that may put them at higher risk of complications. 但不同种族和民族的问题有所不同. CDC data from 2007 to 2016 show that Hispanic mothers were at higher risk of dying from blood pressure-related issues than white or Black women.

西班牙裔妇女在怀孕期间往往表现出最佳的健康行为, 社会流行病学家艾玛·桑切斯-瓦兹诺说, 他是旧金山州立大学公共卫生系的教授. "For example, they are less likely to smoke and drink alcohol during pregnancy,她说.

但 they often find themselves at the bottom of the economic ladder in jobs that do not provide insurance, 她说. 根据 U.S. 卫生与公众服务部, in 2019, Hispanic mothers already were less likely to receive prenatal care – and when they did, 与白人母亲相比，这是在怀孕后期.

研究表明，当大流行来袭时, 西班牙裔占前线劳工的很大一部分, 拉丁裔在容易倒闭的行业中就业的比例过高.

这些经济力量, combined with existing socioeconomic issues that make it harder for people with low incomes to eat healthy food or live in safe, 绿色的散步场所, 骑自行车和锻炼, "served as sort of a 'perfect storm' that can give rise to more ill health and death in this group,桑切斯-瓦兹诺说.

COVID-19直接影响了一些孕妇, 哪些人患重病的风险更高. 西班牙裔人也有较高的感染风险, which 可汗说: "was largely due to employment concerns without the privilege to work remotely at home during the time period when there were not vaccines."

由于卫生系统在2020年陷入混乱, 获得医疗保健的机会已经有限的人将遭受最大的损失, 她说.

During the first year of the pandemic, many pregnant women avoided clinics, said Dr. 帕特里克·拉姆齐, a professor and chief of the division of maternal-fetal medicine at the Long School of Medicine at the University of Texas Health Science Center at San Antonio. 像先兆子痫这样的情况需要持续的医疗监测.

“如果你有间隔访问, 或者你不去诊所做适当的评估, that disease can become worse than it would have been if you'd come in on a regular basis,拉姆齐说。, who is also chief medical officer for the Texas Collaborative for Healthy Mothers and Babies.

拉姆齐, 这个城市近三分之二的人口是西班牙裔, 语言障碍, misinformation and medical mistrust can prevent Hispanic people from getting crucial information.

为了解决这个问题, Khan and 拉姆齐 both emphasized the need for better care not just to protect the health of pregnant women, 而是为了在她们怀孕之前保护她们.

为了实现这一目标，定期产前检查的障碍必须消除. 拉姆齐说:“也许这是需要消除的经济障碍。. “也许这是语言障碍. 也许这是医疗系统的偏见."

汗说，这也适用于黑人女性, 哪个州的孕产妇死亡率在美国最高.

She emphasized the idea of a "zero trimester," or optimizing a woman's health before she is pregnant. "One of the most critical periods where intervention is needed and can have the greatest impact is pre-pregnancy, but is often limited due to fragmented health insurance or limited health care access,汗说。.

Part of that is ensuring access to contraception to prevent unintended pregnancies, the experts said.

可汗说: women also need to "know their numbers" on critical heart health measures such as blood pressure, 总胆固醇, 血糖和体重指数. “经常, young people feel like they are invincible and don't think of pregnancy as being a time when something life-threatening can occur,她说.

但, 可汗说:, being aware of both the risks and the ability to limit them "can go a long way" toward helping a pregnant woman protect her health.

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