Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome

( Obstet Gynecol. 2023;142:911–919) Research has clearly shown that health care outcomes are riddled with disparities surrounding race, but arguments exist about whether these disparities are due to biological differences, environmental, structural, or social elements of overall health, or systemic racism and inherent racial bias. Many observed differences in pregnancy outcomes are consistent even when correcting for poverty, educational status, or income level, suggesting that there are other factors that have not yet been identified. This commentary proposes that structural racism is a major contributing factor to health disparities between those of different races, including aspects such as access to healthy food options, psychosocial stressors, and safe and healthy living environments, and these differences will be manifest in the gut and vaginal microbiomes, thus affecting pregnancy-related outcomes related to the microbiome.