An exploration of reproductive health issues that disproportionately affect Black women
Nyia L Noel, MD, MPHAssistant Professor of Medicine Boston University School of Medicine
Studying racial disparities in the prevalence of hypertensive pregnancy disorders and uterine fibroids
Across America, women of color and their babies consistently have worse health outcomes than their white peers. As an OBGYN working at a safety hospital, I see first-hand the many inequities in women’s health, particularly with regards to maternal morbidity and mortality. That’s why I was excited to join the All of Us Research Program at Boston Medical Center, to help increase participation in medical research by groups that have been previously underrepresented and to study how racial disparities impact their care and outcomes.
Black women and mothers:
- Face an acute risk of maternal mortality, dying at rates that are 3 to 4 times higher than white mothers
- Are disproportionately impacted by pregnancy-related risk-factors such as hypertension
- Are three to four times more likely to get uterine fibroids than women of other races, often demonstrating more symptoms, more frequently, and with worse outcomes
- Are at higher risk for experiencing other reproductive health issues
I am involved in two demonstration projects using the All of Us Research dataset. The first project involves the epidemiology of hypertensive disorders of pregnancy and the second project involves the epidemiology of uterine fibroids.
Hypertensive disorders in pregnancy include pre-eclampsia, eclampsia, gestational hypertension, and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) which can increase the incidence of preterm birth and other maternal morbidity and mortality. They are some of the most common complications of pregnancy and
As a Black physician, I hope that the All of Us Research Program will work to rewrite the narrative regarding medical experimentation and the past exclusion of marginalized populations and create more participation in research by these populations.
Nyia Noel, MD, MPH
are caused when high blood pressure develops, often without obvious signs or symptoms, adversely impacting both mother and baby during pregnancy.
Uterine fibroids are benign tumors of the uterine muscle. This prevalent gynecologic condition disproportionately affects black women and can cause heavy periods, pain, and issues with fertility.
I chose these two projects because of their outsized impact on the communities of women I treat, and the continued need for better understanding and management. I hope that my experience with the data will serve as a roadmap for both citizen-scientists and medical researchers in the future, paving the way for better care, better treatment, and greater health equity for everyone affected.
As the term “precision medicine” suggests, I hope to use what we learn in the study to prevent and treat uterine fibroids in patients with specific demographic, clinical, and social characteristics. Since we know that race is a social construct and not a cause of a medical condition, I think it will be very important to understand how race and social determinants of health impact disease.
The quality and diversity of the data within the All of Us Research Program is so important because it allows us to obtain more generalizable results when studying specific conditions and disease states. In order to apply results to a diversity of patients, conditions must be studied in diverse populations. As of December 2020, approximately 75% of the participants whose data appear in the Researcher Workbench come from communities that are historically underrepresented in research, such as people of color and sexual and gender minorities. This gives us an opportunity to conduct research in a much more representative way.
As a Black physician, I hope that the All of Us Research Program will work to rewrite the narrative regarding medical experimentation and/or the past exclusion of marginalized populations and create more participation in research by these populations to improve health.
I think it will be really interesting to engage and partner with citizen-scientists and am proud to be a part of this historic and groundbreaking program.
Learn more about Nyia’s work at www.prenatalaspirin.com.
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