Gregory, who also is vice chair of Women’s Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology, told Healio that Black women in the U.S. have an increased risk of developing many health conditions, including cardiovascular disease, breast cancer, and pregnancy-related complications that can sometimes lead to death.

“Black women have two to three times a higher … rate of maternal mortality compared to white women,” Gregory said.

She told Healio that multiple factors contribute to this disparity, including lack of insurance and access to appropriate healthcare.

“However, even in ideal circumstances, the impact of intergenerational structural racism and implicit bias contributes to these ongoing disparities,” Gregory said.

She told Healio that Cedars-Sinai is partnering with community organizations to reduce these disparities by offering doulas and midwives to support patients giving birth, providing a Reproductive Psychology Program to address depression and anxiety, and capturing patient feedback about the childbirth experience so that the medical center can make improvements where needed.

“And then finally, just increasing the awareness of complications of pregnancy, because most deaths occur in the postpartum period. So, we make sure that we are spending a lot of time educating women about what the warning signs are that should prompt them to come back,” she said.

Gregory, who holds the Helping Hand of Los Angeles—The Miriam Jacobs Chair in Maternal-Fetal Medicine at Cedars-Sinai, told Healio that she encourages all physicians—not only obstetrics and gynecology specialists—to pay close attention to their maternal patients’ needs.

“See these patients; don’t be afraid of pregnant women or recently postpartum women,” Gregory said. “They can benefit from your expertise as well.”

Click here to watch the entire segment on Healio.

Addressing the complexity of causes behind poor health outcomes for Black mothers requires commitment, investment and innovation to produce meaningful, measurable change.

“Ensuring equitable outcomes for our patients is a priority at the highest level of Cedars-Sinai. Black Maternal Health Week raises awareness about birthing inequities that exist, and the multidisciplinary work required to close the gap,” said Christina Harris, MD, Cedars-Sinai vice president and chief health equity officer.

“But the work of preventing harm and saving Black lives is a continuous process that is not confined to one week. It is 24 hours a day, seven days a week, every week and every year. That is the level of commitment that is required,” Harris said.

Cedars-Sinai initiatives to improve Black maternal health include lowering the rates of a common cause of death during childbirth, funding community partners, providing mandatory anti-discrimination education and bridging the gap in maternal mental health care.

Community Conversations

Throughout the year, Cedars-Sinai partners with BlackDoctor.org for a series of Community Conversations that address a wide range of health and public health concerns. This month’s conversation will focus on Black maternal mental health.

According to the American Counseling Association, Black women face an increased risk of perinatal mood and anxiety disorders, including depression and post-traumatic stress disorder. On April 10, “Shining a Light on Black Maternal Mental Health” will feature a panel of healthcare experts discussing the importance of early diagnosis and access to support and effective treatment. The conversation will include an inspirational Black mom who shares her journey of recovery from serious postpartum depression. 

AI Plus Aspirin Eliminates Racial Disparities in Preeclampsia Treatment

"Whenever we focus on eliminating racial or ethnic disparities in care, we ultimately end up increasing the quality of care for everybody,” said maternal-fetal medicine specialist Melissa Wong, MD.

Aspirin can reduce the risk of developing preeclampsia, a dangerous hypertensive complication of pregnancy that can lead to serious complications and even death. But Black pregnant women are particularly vulnerable to being overlooked for aspirin treatment.  

A study led by Wong found that using artificial intelligence to automate decision-making about prescribing low-aspirin—and to identify patients at risk for preeclampsia—resulted in an increase in appropriate aspirin treatment and eliminated the racial disparity in care.

Perinatal Antidiscrimination Initiative

“Not being heard, or having assumptions made about you or your condition, can be a critical barrier to getting good medical care. I've found there are differences in how people perceive respect, or disrespect, based on race and ethnicity," explains Kimberly Gregory, MD, MPH, director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology.

“Always Listening and Learning with You”—ALLY—is a phrase developed by the Cedars-Sinai perinatal unit to characterize an effective approach to patient advocacy and health equity.

The principal of “allyship” is the foundation of annual department compliance training on unconscious bias. The course demonstrates the value of inclusive terminology, offers opportunities to explore how to advocate for  patients and colleagues and emphasizes the critical role staff members play in improving the experiences of patients.

Black Maternal Mental Health

“Black women are twice as likely to experience perinatal mood and anxiety disorders, including postpartum depression, than their white counterparts. They are also less likely to receive treatment,” said clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program.

Cedars-Sinai investigators are recruiting participants for an NIH funded study aimed at addressing those disparities. The Resources, Inspiration, Support, Empowerment (R.I.S.E.) for Black Maternal Mental Health study tests a mobile health web application designed to help manage stress in pregnancy.

Black women living anywhere in the U.S. who are 12-32 weeks pregnant and at least 18 years old can participate in the study. Click here for more information.

Community Partners

Cedars-Sinai also partners with trusted community organizations committed to improving Black maternal and infant health.

Since 2022, Cedars-Sinai has committed over $3.5 million to 14 organizations which focus on reaching perinatal and postnatal Black women in Los Angeles County, across the continuum of care. Grantees include highly respected partners such as the California Black Women’s Health Project, which provides health education and other resources meant to build empowering relationships within the community of Black pregnant and parenting women they serve.

“Striving for health equity among all populations has long been a goal of Cedars-Sinai. These organizations are key partners in that mission. The grants—and opportunities to combine resources for the good of public health—are an important way we can contribute to improving Black maternal health and well-being,” Harris said.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color                           

Formerly known as the California Pregnancy-Associated Mortality Review (CA-PARM), the committee conducts in-depth investigations of deaths during—and up to one year after— pregnancy. The goal is to identify the causes of maternal loss of life, and any contributing factors, in order to develop evidence-based recommendations for prevention.

CA-PARM was established in 2006 by the California Department of Public Health, in partnership with the California Maternal Quality Care Collaborative, where Gregory has also served.

“We couldn't be more excited about Dr. Gregory's appointment to lead CA-PARC. Her leadership experience with the state committee, a distinguished career as a maternal-fetal medicine specialist, and her critical research on maternal health outcomes and disparities make her perfectly suited for this role,” said Amanda Williams, MD, MPH, the Clinical Innovation Advisor at the California Maternal Quality Care Collaborative.

Gregory is the director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai.  

“Death associated with pregnancy is a tragic event, impacting families and communities. Each woman who died while pregnant, or in the postpartum period, deserves a thorough and respectful review of what contributed to their death. It is my honor to serve as chair of CA-PARC and to work with a team who is thoughtful and diligent with this sensitive review process. We are dedicated to work that may keep others from dying from preventable causes,” said Gregory, who holds the Helping Hand of Los Angeles–Miriam Jacobs Chair, Maternal-Fetal Medicine.

Gregory joined Cedars-Sinai in 1992, after receiving her medical degree from the Drew/UCLA Medical Education Program and completing her residency in obstetrics and gynecology at Beth Israel Deaconess Medical Center in Boston. She went on to earn a master’s degree in public health from Harvard University before completing a fellowship in maternal-fetal medicine at LAC+USC Medical Center.

A major focus of Gregory’s research over the past decade has been examining the hospital childbirth experience from the mother’s perspective. Her goal is for hospitals to provide a safer and more meaningful experience for women in their care, addressing concerns that range from better pain management to breastfeeding policies.

“Dr. Gregory has been steadfastly committed to improving obstetric outcomes for women for her entire career. She is a compassionate physician whose dedication to providing her patients the best possible care also drives her innovative research to identify and reduce racial and ethnic disparities that can impact the healthcare women of color receive. She wants every pregnant patient to receive the best possible care available,” said Sarah Kilpatrick, MD, PhD, the Helping Hand of Los Angeles Chair of Obstetrics and Gynecology at Cedars-Sinai.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color

The one-hour virtual program, Embracing Our Community: LIVE! Advancing Black Maternal Health, focused on why Black women are three times more likely to die from pregnancy-related causes than white women--a disparity that transcends education, socioeconomic status, and even pre-existing health conditions.

“The inequities around black maternal health in America are critical for us to keep at the forefront of our work,” said Christina Harris, MD, vice president and chief health equity officer at Cedars-Sinai, who moderated the discussion. “This issue embodies every challenge we face in healthcare today, from inequitable access to timely and high-quality care to disparate treatments and outcomes.”

Joining Harris was Kimberly Gregory, MD, MPH, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology, and director of Maternal-Fetal Medicine at Cedars-Sinai; Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai; Sonya Young Aadam, CEO, California Black Women's Health Project; and Natalie Hernandez, PhD, executive director, Center for Maternal Health Equity at Morehouse School of Medicine.

Panelists identified living conditions and experiences that contributed to Black women’s high maternal mortality rate, such as access to healthcare and prenatal care, trauma, childhood abuse, racism, unconscious bias, and sexism.

The panelists also discussed the persistence of disparities in Black maternal health across different socioeconomic levels, emphasizing that economic circumstances alone cannot explain inequities. They also stressed the need to eliminate racism in healthcare as well as in the daily lives of Black families, because of racism’s negative impact on health outcomes.

Conditions such as diabetes, hypertension, and obesity have increased among Black women, leading to complications, including preeclampsia, higher cesarean rates, and an increased risk of bleeding disorders.

"What's happening is that many symptoms experienced by women during pregnancy are often considered typical, when in reality, some of them can be indicative of significant morbidity and mortality,” said Gregory. “As physicians, we must learn to listen and differentiate these symptoms over time.”

Panelists gave advice for pregnant women and their families, emphasizing the importance of open communication with healthcare providers, seeking immediate care for urgent warning signs, documenting pregnancy history, and maintaining healthcare and social support systems throughout the pregnancy journey.

“For years we've had guidelines make in-hospital care better, but most deaths are actually postpartum,” said Kilpatrick. “We need to do a better job of making, what’s now being called the fourth trimester, postpartum care for women after giving birth easier. Make it covered by insurance, provide accessible follow-up, whether virtual or in-person, to ensure mothers can receive care in their own environment.”

Panelists also identified changes in policy and the healthcare delivery system that are essential for improving Black maternal health in the United States. These changes include: 

• Reviewing the causes behind every maternal death
• Ensuring access to prenatal and maternal care
• Addressing social factors like housing, transportation, and food insecurity
• Increasing diversity among healthcare professionals.

“My hope is sort of echoing Martin Luther King's dream and that one day it won't matter what color your doctor is, that you're going to get the right care at the right time for your right condition,” Gregory said.

Read more on the Cedars-Sinai Blog: How Cedars-Sinai is Working to Improve Black Maternal Health