# Pregnancy-Associated Mortality

> **NIH NIH R01** · TULANE UNIVERSITY OF LOUISIANA · 2022 · $284,388

## Abstract

PROJECT SUMMARY/ABSTRACT
There is a critical need to identify reasons behind the entrenched and unacceptable racial
inequity in mortality during pregnancy and postpartum in the US. Compared to White women
Black women are 3-4 times more likely to die from both obstetric and non-obstetric causes.
Previous efforts focused on individual-level and health care factors underlying differences in risk
that have failed to explain the inequity, raising the concern that broader societal and structural
conditions may at play. Moreover, despite evidence suggesting homicide is a leading cause of
death during pregnancy and postpartum, it remains severely understudied. Failure to identify
and address factors underlying pregnancy-associated homicide will perpetuate racial inequity in
mortality during pregnancy and postpartum. Our overall objective in this application is to
examine how key features of the social context in which women live – income inequality,
structural racism, community violence, and spatial social polarization – increase their risk of
death during pregnancy/postpartum and contribute to racial inequity in mortality. We will build
upon and expand our existing vital records and social contexts databases to establish a system
for public health monitoring of both distributions of health determinants and maternal population
health across the country. This includes ongoing analyses of historical to the most recently
available national death records and linkage of death, birth, and fetal death vital records from
the state of Louisiana. Our specific aims are (1) To identify which social contexts (income
inequality, structural racism, violence, and spatial social polarization) increase risk for
pregnancy-related mortality while developing a national geodatabase for monitoring trends in
both social contexts and maternal deaths across the US, (2) To identify which social contexts
(income inequality, structural racism, violence, and spatial social polarization) increase risk for
pregnancy-associated homicide and to monitor trends in both over time, and (3) To identify
distinct mediating pathways between social contexts and pregnancy-related mortality and
pregnancy-associated homicide. The research includes two analytic designs: 1) national
ecologic analysis of county-level pregnancy-related mortality and pregnancy-associated
homicide, complemented by 2) local multi-level and mediation analysis to estimate individual-
level mortality risk during pregnancy/postpartum. Findings from this work will include never
before documented evidence of the social epidemiology of pregnancy-associated mortality and
identification of targets for programmatic and policy intervention aimed at interrupting the
pathway between adverse social contexts and death among pregnant and postpartum women.

## Key facts

- **NIH application ID:** 10443693
- **Project number:** 5R01HD092653-05
- **Recipient organization:** TULANE UNIVERSITY OF LOUISIANA
- **Principal Investigator:** Maeve E Wallace
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $284,388
- **Award type:** 5
- **Project period:** 2018-08-27 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10443693

## Citation

> US National Institutes of Health, RePORTER application 10443693, Pregnancy-Associated Mortality (5R01HD092653-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10443693. Licensed CC0.

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