# A Health Equity Paradigm Shift:   Predictors of Healthy Pregnancy in African American Women

> **NIH NIH K23** · WASHINGTON UNIVERSITY · 2020 · $162,000

## Abstract

ABSTRACT
African-American women bear a disproportionate burden of maternal morbidity and mortality in the United
States, regardless of socio-economic, educational, or marital status. Fortunately, maternal death rarely occurs
without warning. Pregnancy complications, such as those that increase the risk of future cardiovascular
disease (preterm birth, growth restriction, preeclampsia, and gestational diabetes), or severe maternal
morbidity (SMM) can serve as sentinel events that herald the impending possibility of a mother's increased risk
for maternal mortality (MM). Most health disparities studies to date have used a deficit-based model and have
included white women as the reference group to identify detrimental factors. In this supplement, I propose to
instead use a strength-based model that utilizes African-American women with healthy pregnancy outcomes as
the reference group. I will compare them to African American women with pregnancy complications to identify
protective factors because African American women with healthy pregnancies may provide key insight to
inform future prevention strategies. The objective of this supplement is to identify environmental, systems,
behavioral, medical, and biological constructs that predict a healthy, uncomplicated pregnancy in African-
American women. The proposed supplemental study leverages a rich repository of clinical, survey and
biospecimen data from a contemporary cohort of 852 African American women enrolled in an observational
preterm birth study from 2017-2020, 549 (64%) of whom went on to have a healthy pregnancy, free from
complications that predict future cardiovascular disease. I will use two complementary approaches, multi-level
modeling and machine learning, to quantify the relative contributions of modifiable protective factors to a
healthy pregnancy across multiple levels and domains of influence. Using an adaptation of the National
Institute on Minority Health Disparities Research Framework, I will identify factors that protect African-American
women from pregnancy complications that predict future cardiovascular disease (Aim 1.1), SMM (Aim 1.2),
and a composite morbidity index combining the two (Aim 1.3). Finally, the work of interpreting the empirical
findings from Aim 1, to develop potential interventions and policy changes, will begin in Aim 2. This aim is
aspirational in nature, but included in this brief supplement to stress the importance of identifying actionable
items from study findings of protective factors that are most amenable to targeting through interventions and/or
health policy. A team of diverse stakeholders, including a Maternal Advisory Panel of African American
Mothers, Clinicians, and Perinatal Researchers will use intervention mapping (a rigorous method that has
been used to create behavioral health interventions) to review study findings, methodically think through ways
to translate study findings into action, and make recommendations for future directions that a...

## Key facts

- **NIH application ID:** 10200462
- **Project number:** 3K23HD095075-03S1
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Ebony Boyce Carter
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $162,000
- **Award type:** 3
- **Project period:** 2018-09-08 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10200462

## Citation

> US National Institutes of Health, RePORTER application 10200462, A Health Equity Paradigm Shift:   Predictors of Healthy Pregnancy in African American Women (3K23HD095075-03S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10200462. Licensed CC0.

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