It’s well-documented that pregnancy outcomes differ among ethnic groups. If you are from an Asian cultural background, there can be added challenges to receiving the best care: from language barriers to educational materials that don’t take cultural and ethnic background into account, the experience of pregnancy is different for Asian Americans. For Asian American and Pacific Islander Heritage Month, I wanted to share some of what I have experienced as an OBGYN taking care of diverse populations, and what I experienced myself as an Asian woman during my pregnancy journey.
I work as an OBGYN in Rochester, MN, where there is a fairly large Asian population. I frequently see Burmese and Cambodian patients, many of whom are immigrants and don’t speak English as a first language. Unfortunately, a number of my Asian patients have developed poorly controlled gestational diabetes (GDM). Asian people are at higher risk of developing GDM, which also means higher risk of developing Type II diabetes later in life. For babies of moms with gestational diabetes, there is a greater risk of macrosomia (or being larger than normal), which can lead to complications at the time of delivery. Other consequences of poorly controlled GDM include higher risk of c-section, preterm birth, and stillbirth.
When appropriately managed, patients with gestational diabetes can have healthy deliveries. But for my Asian patients, I believe that a lack of education and culturally sensitive resources gets in the way of adequate care. Effectively communicating and implementing dietary changes is hard enough with an English speaking patient. When you introduce a language barrier, education on culturally-informed topics like diet and exercise takes a lot more time and resources. This can result in Asian patients not getting the information they need to control their GDM. Moreover, most nutritional guidelines aren’t culturally specific: when you’re coming from a different starting point with your diet, with different cultural expectations around traditional foods, it can be more difficult to adhere to a brand new, Western-centric nutrition plan.
The majority of our guidelines in U.S. obstetrics practices were created with white populations as the baseline. For example, if a pregnant person has a prenatal ultrasound to measure the size of their growing baby, the OBGYN uses intrauterine growth curves to assess whether the fetus is growing at the right rate. But when we try to apply these curves to people of different ethnic backgrounds, specifically Asian populations, a lot of the time these standards don’t apply. In my own pregnancy, my baby was diagnosed with growth restriction. However, my OBGYN knew that these estimates often incorrectly estimate fetal growth for Asian patients. This is also a common problem for Indian patients, and patients of other Asian backgrounds.
Even though my doctor was able to tell me that my fetal growth might be totally normal, I was left with uncertainty given the lack of data-based guidance for Asian patients. When the standards are based around white populations, how can we determine for our Asian patients whether something is pathological or simply a normal variant? Overall, we need more data on how pregnancy varies for different ethnic groups to provide the same standard of care for all of our diverse patients.
I co-founded Delfina so that all patients, regardless of ethnicity, would be able to access personalized pregnancy care and educational resources. Delfina’s machine learning-optimized care platform uses data from multiple different sources to help create tailored predictive models that appropriately represent patients of all racial and ethnic backgrounds. We offer Delfina Care in both English and Spanish, as our current deployments serve Spanish-speaking populations. Together, we can create new, culturally specific standards and educational options so that no patient is left to manage a difficult pregnancy on their own.
