Hyagriv Simhan, MD, MS, is executive vice chair of obstetrical services at UPMC Magee-Womens Hospital and director of clinical innovation for UPMC women’s health services. His pioneering research on premature births — funded by the Magee-Womens Research Institute and the National Institute of Child Health and Human Development — has received national recognition. Dr. Simhan also is a leader in promoting increased safety and health care quality for pregnant women.
What Led You to Specialize in Maternal Fetal Medicine?
I’ve wanted to be a doctor since I was a child. My intent was to do heart transplants, so as a medical student at Boston University, I did some research in that area. I was pretty confident that’s what I wanted to do. But during a rotation at Boston City Hospital, I found myself drawn to obstetrics and gynecology.
As a resident, I started focusing on complicated obstetrics and how to optimize the health of both mother and baby. That path led me to maternal fetal medicine (MFM) and the knowledge gaps that exist in the health needs of both mother and child. I came to UPMC for an MFM fellowship 22 years ago and have been specializing in that area since then.
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In your research, you identified that premature births among Black women are nearly double that of whites and Hispanics, and that premature Black babies die at a significantly higher rate than other racial groups. What are some of the contributing factors to those statistics?
There are many disparities contributing to health outcomes in addition to race, and that’s certainly true in pregnancy. Researchers have explored how biology, environment, health, and disease affect fetuses as they develop — and how they affect pregnant women both during and after pregnancy.
We also know there are many social factors that contribute to the health of a mother and child, such as access to care and the quality of the health care experience. Patient engagement with a system of care can vary by many factors, and race is one of them.
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Only about 20% of all health care outcomes are actually the direct consequence of health care interventions. The other 80% are related to other things, like the safety of the neighborhoods we live in, the availability of healthy foods to eat, and the opportunity for leisure time and physical activity.
It’s said that our ZIP code is a greater predictor of our health and wellbeing than our genetic code. But in recognizing that social determinants contribute to adverse health outcomes, it’s also important to understand we have the ability to improve. We don’t get to change our genetics. But as a society, we do get to influence our structures and policies. We can become more fair in assuring good access to care.
How is your research and clinical work helping to address racial disparities in health care?
At UPMC Magee, we’re very cognizant of the fact that there are health disparities for Black Americans and other racial groups here in Pittsburgh and throughout the country. From both a research perspective and in our role as clinical leaders, we’re committed to contributing to the conversation and to improving these circumstances.
For example, women with high blood pressure during and after pregnancy have a much greater risk of dying after delivery. Black women have a higher incidence of hypertension during and after pregnancy.
We’ve developed an innovative virtual program to monitor and manage postpartum hypertension. The program identifies women who are at risk and connects them to better health care through educational resources and risk assessment. We’re helping them to be informed and supporting their adherence to prenatal care. We’re also linking them to ongoing preventive care with the goal of minimizing the harm of hypertension across the course of their lives. While helping to improve health for all women postpartum, programs like this also help narrow disparity.
What is the role of health care systems in addressing racial disparities?
So much of what happens in the health care environment is affected by what we do outside of it. Outreach services and engagement with community stakeholders cannot be an afterthought. They’re essential to maximize and optimize health care outcomes. We as a health care system need to own that.
We can begin by giving an effective voice to those individuals and communities who have not been heard before. Just as importantly, those of us in health care need to be a receptive audience. We need to listen and make sure that we actually understand the problem and hear the voices of those most affected by these problems. We can’t function in a vacuum, developing interventions or coming up with answers without a collaborative effort.
And we must do our part to address our unconscious bias as care providers. We need to better understand what women of color expect from their pregnancy and birth experience. That will enable us to narrow disparities, engage populations, and enhance trust.
How are you working to build trust among women of color?
We are constantly working to engage patients, enhance cultural competency, and maximize health literacy. For example, studies show that doulas can play a vital part in ensuring that a patient’s voice is heard, care adherence is maximized, and that the patient’s perspective and wishes are followed. At UPMC Magee, we are working to integrate doula professionals into our health care teams. When a woman “clicks” with her doula — a laywoman specially trained in childbirth — that relationship provides invaluable advocacy, education, and support before, during, and after delivery. It’s a tangible way for us to improve the lives of women during pregnancy and in the postpartum period to help them form a closer, more trusting bond with their entire health care team.
How has COVID-19 impacted your work?
It’s safe to say that no aspect of American life has been untouched by COVID-19. But compared to many other health care fields, obstetrics marches on. During COVID-19, our business of delivering babies has remained consistent.
From the very start of COVID-19, we worked hard to find ways to use virtual technologies to protect our moms and babies, and our staff. Fortunately, we’re part of a system that’s been on the cutting edge of using telemedicine for some time. We were able to adapt very quickly, completing more than 6,000 virtual prenatal visits interspersed with face-to-face visits.
Telemedicine essentially allows us to bring our care to a patient’s home. It improves the patient experience by maintaining a high degree of communication with the provider using a lower resource footprint. Delivering that kind of care makes it easier for the patient on countless levels.
Are you hopeful for the future?
I’ve recognized the gravity of racial disparities for a long time. What I see that gives me hope is the degree of attention it’s now getting across a broad swath of society. My hope is that this broad range of support brings immediacy and action to these problems. Problems of racial disparities and differences in women’s health outcomes didn’t happen overnight, and they likely won’t be resolved in 2020. But the current sense of urgency is creating a real momentum that has me feeling positive about the future.
Health disparities are preventable and disproportionate health conditions that exist among all ages in certain populations. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles.