Vitamin D deficiency is associated with lower pregnancy rates in non-Hispanic whites, but not in Asians, possibly due to their lower IVF success rates. Vitamin D deficiency was not correlated with ovarian stimulation parameters or with markers of embryo quality, suggesting its effect may be mediated through the endometrium.
On the basis of the documented racial disparities in ectopic pregnancy incidence and mortality we hypothesized that African-American women with ectopic pregnancy would be more likely than white women to have treatment failure with methotrexate. In this retrospective cohort study, a racial disparity in methotrexate effectiveness was not found, but a significant relationship between low socioeconomic status and methotrexate failure was demonstrated.
KeywordsEctopic pregnancy; methotrexate; diagnosis; race; health disparity; socioeconomic statusThe incidence of ectopic pregnancy (EP) and its associated mortality represent a persistent racial health disparity in gynecology. According to the most recent estimates from the Centers for Disease Control and Prevention, minority women have a nearly twofold increased incidence of EP and a nearly fourfold greater risk of EP-related mortality than white women (1,2). This racial divide has been attributed to differential health care access that allows for elaboration of risk factors for EP and delays the diagnosis of incident EPs (1,(3)(4)(5)(6)(7)(8). Both gonorrheal and chlamydial infections are more prevalent in samples of African-American women than whites (3-8); the fact that these infections are often asymptomatic (9) suggests that African-American women are likely undertreated relative to whites. The sequelae of increased pelvic infections are reflected in the assisted reproductive technology literature, with numerous reports demonstrating higher proportions of tubal factor infertility in African-American women seeking care and more EPs resulting from treatment compared with white patients (2,10-12). In addition, population-based studies have demonstrated that self-reported infertility is up to twofold higher in African-American women than whites, which may be attributable in part to tubal damage from pelvic infections (10,(13)(14)(15) Despite the well-documented racial disparities in EP incidence and mortality, there is little extant literature specifically comparing outcomes of medical management of EP by race or ethnicity. Although extensive research has demonstrated methotrexate (MTX) to be highly effective, failure rates have been variable from as low as 4% to as high as 36% depending on the treatment protocol used (16)(17)(18)(19)(20). Anticipated poor patient follow-up is a notable contraindication to the administration of MTX for EP treatment (19,20). Thus, it is plausible to consider that the documented association between race and barriers to health care access (1,3,4,17,18,(21)(22)(23)(24) may increase the risk of MTX failure of EP treatment.The primary objective of this investigation was to test the hypothesis that African Americans have a higher risk of MTX treatment failure of EP than whites. Socioeconomic status (SES) is known to differ across racial strata and to contribute to health disparities, at times predicting health outcomes more powerfully than race (21,22,25). Therefore, an additional aim of this study was to test the association betwee...
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