# Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

> **NIH NIH R01** · STANFORD UNIVERSITY · 2020 · $200,777

## Abstract

ABSTRACT (from parent grant R01 NR017020)
Severe Maternal Morbidity (SMM) includes serious threats to maternal health and survival that occur at
delivery or postpartum. Based on the SMM index developed by CDC that focuses on the most life--threatening
conditions and complications, the prevalence of SMM doubled from 1998-2011 and currently affects >65,000
women in the U.S. each year. Maternal health is essential to a woman’s ability to care for her children and to
her health over her life course, yet our understanding of causes of SMM is limited. This proposal addresses
three key and understudied areas of research for SMM: racial/ethnic disparities, maternal weight, and
social disadvantage. Racial/ethnic disparities in SMM and its contributing conditions are well known – risk of
SMM tends to be up to 2-fold higher among non-Hispanic blacks and 1.5-fold higher among Hispanics and
Asians, relative to non-Hispanic whites. The explanation for these disparities is unknown, but preliminary
evidence suggests that maternal weight and social disadvantage may contribute. In the U.S., 25% of women
are obese at conception, half gain excessive weight during pregnancy, and 25% retain >10 lb. postpartum, but
this varies by race--ethnicity. Some studies suggest an association of obesity with SMM, but few have
examined severity of obesity, underweight status, or weight change. Social disadvantage is much more
common among non--whites than whites and associated with myriad perinatal outcomes, but almost no studies
have examined its contribution to SMM. Unusually high and low maternal weight and weight gain are most
likely among socially disadvantaged women, but their inter-related impacts on SMM have not been studied.
Our goal is to increase understanding of biologic and social determinants of SMM and its racial/ethnic
disparities, by analyzing 4 million births that occurred in California from 2007--2014. The data include vital
records and mother and infant hospital discharge data from pregnancy through postpartum. Outcomes will
include the most common conditions that contribute to SMM – postpartum hemorrhage, eclampsia/severe
preeclampsia, select cardiovascular conditions, and sepsis – as well as the SMM index developed by CDC.
The Specific Aims are: 1) Examine associations of maternal weight status before, during, and between
pregnancies with SMM and whether they are modified by race/ethnicity; 2) Examine associations of multi-level
(individual, household, neighborhood) indicators of social disadvantage with SMM, overall and by race/ethnicity
(Aim 2a), and the extent to which these relationships are mediated by maternal weight status (Aim 2b); and 3)
Investigate the contribution of maternal weight status and social disadvantage to the population burden of
SMM and its racial/ethnic disparities. The proposed research will break new ground by studying the complex
relationships among maternal weight, social disadvantage, racial/ethnic disparities, and SMM. This knowl...

## Key facts

- **NIH application ID:** 10091301
- **Project number:** 3R01NR017020-03S1
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** SUZAN L CARMICHAEL
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $200,777
- **Award type:** 3
- **Project period:** 2018-01-19 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10091301

## Citation

> US National Institutes of Health, RePORTER application 10091301, Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight (3R01NR017020-03S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10091301. Licensed CC0.

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