We appreciate Holtzman’s interest in our efforts to gain insight into the reasons for racial disparities in maternal mortality. The persistent 3- to 4-times greater risk of pregnancy-related mortality for Black women is the largest gap among the traditional indicators of maternal and infant health in the United States. We, too, are concerned that racial disparities also exist for infant outcomes and that they, like those for pregnancy-related mortality, remain largely unexplained.
The role of stress, neuroendocrine pathways, and immune system functions are all areas of biomedical research that we hope will help us to better understand why some groups have increased risks for adverse health outcomes. In addition, as implied by Holtzman, we must make efforts to understand how biology is affected by the larger context of women’s lives. Further, while we work to identify and change factors that convey susceptibility to pregnancy complications, preterm birth, and infant mortality, it is critical to improve access and quality of care for all women and infants.
Note. The findings and conclusions in this letter are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.