There is growing evidence that rural and racial disparities and social determinants of health (SDOH) impact adverse pregnancy outcomes (APOs) and overall maternal mortality in the United States. These APOs, such as preeclampsia, preterm birth, and intrauterine growth restriction, are in-turn associated with increased risk of future cardiovascular disease (CVD) later in life. Importantly, SDOH such as socioeconomic disadvantages, poor health literacy, transportation barriers, lack of access to adequate health care, food insecurity, and psychosocial stressors have cascading effects on APOs and downstream cardiovascular health. These SDOH are also deeply intertwined with and compounded by existing racial and rural disparities. Pregnancy thus provides a unique opportunity to identify at-risk women from a social determinants perspective, and provide early interventions to optimize long-term CVD and mitigate cardiovascular health disparities. Addressing the challenges posed by these disparities requires a multi-pronged approach and involves national, regional, and individual level solutions. Eliminating disparities will necessitate a nationwide obligation to ensure health care equity via enhanced health insurance coverage, resource investment, and public and clinician accountability.

中文翻译：

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减少美国不良妊娠结局的差异

越来越多的证据表明，农村和种族差异以及健康社会决定因素 (SDOH) 会影响美国的不良妊娠结局 (APO) 和总体孕产妇死亡率。这些 APO，例如先兆子痫、早产和宫内生长受限，反过来又与日后罹患心血管疾病 (CVD) 的风险增加相关。重要的是，SDOH，如社会经济劣势、健康素养差、交通障碍、缺乏足够的医疗保健、粮食不安全和社会心理压力源，对 APO 和下游心血管健康产生连锁反应。这些 SDOH 还与现有的种族和农村差异深深交织在一起并加剧了这种差异。因此，怀孕提供了一个独特的机会，可以从社会决定因素的角度识别高危女性，并提供早期干预措施，以优化长期心血管疾病并减轻心血管健康差异。解决这些差异带来的挑战需要多管齐下，涉及国家、区域和个人层面的解决方案。消除不平等需要全国范围内的义务，通过扩大医疗保险覆盖范围、资源投资以及公众和临床医生的责任来确保医疗保健公平。