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Despite known issues of racial bias in AI, Dr. Dawnette Lewis says it can still help address wide racial disparities in maternal health outcomes.
Black people in New York face five times the risk of dying because of pregnancy complications compared to white people — a signal that there’s a lot of work to be done, said Lewis, a maternal-fetal medicine specialist and the director of Northwell’s Center for Maternal Health. But she added that health systems are using technology to develop solutions to this crisis – and are making strides.
Lewis said Northwell’s Maternal Outcomes Navigation program, also known as MOMS, for example, uses AI to increase communication with patients and identify pregnancy complications early. The combination of an AI chatbot and a corresponding team of medical professionals has monitored 6,500 postpartum patients in the two years since it launched – and has reduced hospital readmission rates within a month among Black patients by 60%.
Lewis spoke to Crain’s about how the medical community can leverage AI to improve maternal health, despite its current limitations. This interview has been edited for length and clarity.
There’s been attention on the U.S. maternal mortality rate and worse outcomes among Black birthing people for decades. Why do you think this has persisted?
I think mainly it’s related to systemic racism and bias. Oftentimes I think we’ve made the assumption that chronic conditions are a driver, but even when you look at Black birthing patients who are healthy, the disparity remains. There’s more than one element that drives the disparity.
Where do you see examples of systemic racism and bias?
A couple of years ago the NIH had a conference about how AI continues to perpetuate disparities. One of the focuses was on calculators we use in medicine to quantify risks [of certain diseases.] For example, one of the calculators was used to prioritize who gets a kidney transplant, but there was a [figure that placed a bias] on Black patients [in the diagnostic equation.] What happened was Black patients ended up lower on the transplant list even though they were just as in need of a kidney as anyone else. Those calculators are embedded into our medical system and many don’t help but actually hurt [existing disparities.] We have to revisit those, because they are built into all of our electronic medical records.
How do current diagnostic tools like this exacerbate health disparities in the ob-gyn field?
For patients who had a prior cesarean delivery and wish to have a vaginal delivery in their next pregnancy, there’s also a calculator that factors in race. We think it increases the disparity, because when you put in race for a Black patient, it lowers the success rate of a vaginal birth after cesarean [and may be contributing to higher C-section rates among Black birthing people.] When you look at data in the U.S., in whatever state you look at, the cesarean rate for Black patients is higher. There’s currently work to remove that from the calculator.
Northwell uses AI through its MOMS program to identify postpartum patients who need care. What are the benefits of this technology?
When we use AI in the MOMS program, we think about how to use it to help patients communicate with us if they have any issues. We use it as a way to call for help.
I think the boundary is when you use race as a surrogate to help make medical decisions. If you’re predicting a condition like heart disease, then you should factor in risk factors for heart disease – not use race or ethnicity as one of those risk factors.
Where do you see opportunities for investments to address the maternal mortality crisis?
I think AI is a good place to start. Even though this issue is something that’s been talked about, it’s not well-funded. But everyone has a smartphone. I think [making AI chatbots or other technologies available on personal devices] could be a way to bridge the cost.
What are you optimistic about?
When I started in maternal-fetal medicine, we couldn’t get any other disciplines to even look at a pregnant patient. Now, there are articles published in internal medicine journals, hypertension journals, which recognize that pregnancy conditions are risk factors for cardiovascular conditions later on in life. I’m heartened that the American Heart Association takes this seriously, specifically for Black mothers. Specialists aside from obstetricians in maternal-fetal medicine are now investing in women’s health and recognizing that women’s health is not just about nine months of pregnancy.
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Amanda D'Ambrosio , 2024-04-11 11:33:07
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