Babies born to Black mothers are twice as likely to die in the first month than infants born to white women.
But the disparity is even wider among infants conceived through fertility technologies like in vitro fertilization, according to a study published Wednesday in the journal Pediatrics.
The researchers analyzed data for all U.S. births involving single babies (not twins) from 2016 to 2017: more than 7.5 million births. Of those, more than 93,000 children were conceived through medically assisted reproduction, such as IVF.
The findings showed that death rates were four times higher among newborns up to 28 days old who were born to Black mothers who used fertility technologies involving eggs or embryos. That death rate was 1.6% among babies born to Black mothers, compared with just 0.3% for babies born to white mothers.
Death rates were twice as high among newborns of Asian, Pacific Islander and Hispanic mothers who used fertility technologies compared with babies born to white mothers.
There were no significant differences, however, among newborns of Asian, Pacific Islander, Hispanic or white mothers who conceived spontaneously, without medical assistance. But death rates were twice as high among newborns of Black mothers who conceived spontaneously.
The study’s lead author, Dr. Sarka Lisonkova, an associate professor of obstetrics and gynecology at the University of British Columbia, said most infant deaths happen "within the first day because something has gone wrong either with pregnancy or childbirth or the baby was not developing well in utero."
The study results were surprising, she said, because her team initially thought women who could afford IVF would have access to high-quality health care during pregnancy, regardless of race. Such medical attention and quality care, they theorized, might lead to lower rates of infant death.
But structural racism affects women of color who use reproductive technologies, said Dr. Madeline Sutton, an OB-GYN in Atlanta, who wasn't involved in the research. For instance, they are refused extra tests or treatments or are referred less frequently to specialists, or their health concerns are dismissed.
"Once that pregnancy happens, the women are in the same system that has all those things that we haven’t yet fully accounted for — the systemic biases, the racism, the differences in treatments based on what type of insurance someone might have," Sutton said.
Black women are three times more likely than white women to die from pregnancy-related issues, according to a 2020 analysis from KFF, a nonprofit think tank focused on health. Black women are also twice as likely to have stillbirths or preterm births than white women, according to Lisonkova's study.
Dr. Tia Jackson-Bey, a fertility specialist and OB-GYN at Reproductive Medicine Associates of New York, said the study’s results made sense to her, because Black women tend to wait longer to access fertility treatments than white women.
"Black women actually access care, on average, almost two years later than other women their age with the same issue. So that means that they’re coming to us with more significant infertility with a longer burden of insecurity, and that does affect their IVF outcomes or their infertility treatment outcomes," said Jackson-Bey, who wasn’t involved in the new research.
Indeed, Black women in the study who conceived using fertility treatments were slighter older on average than white women who did so. The added age could increase their risk of preterm delivery, Jackson-Bey said.
The process of fertility treatment itself can also worsen health risks for Black mothers and their infants, Lisonkova said: "There’s basically a long chain of things that have to go right in order to have a successful pregnancy and a healthy baby."
She added that sometimes, the health conditions that led to a woman’s fertility struggles — such as obesity or polycystic ovary syndrome — may lead to complications during pregnancy.
Overall, women who conceive through IVF have a higher risk of stillbirth than women who conceive spontaneously, and infants born to mothers who use fertility technologies have a higher risk of dying within the first year of life.
But the risk of negative outcomes from IVF is minimal overall, Lisonkova said.
“The absolute rates are very low, so that shouldn’t preclude women from seeking fertility care," she said.