New York, NY —

The city is examining why the rate of pregnancy-related deaths in New York City is two times the national average.

There are 23 maternal deaths per 100,000 births in the city, and there's been no significant drop since 1990.

The Health Department studied the cases of the 161 women who died due to complications from pregnancy between 2001 and 2005. The study found that the women who died were more likely to be obese, more likely to be black, more likely to be uninsured and more likely to be older.

Assistant Health Commissioner Deborah Kaplan calls the racial disparity dramatic. "Between 2001 and 2005, black women were more than seven times more likely to die than white women," she says. Kaplan says while the city hasn't figured out exactly why, research shows black women are more likely to be obese and uninsured and they also live in poor neighborhoods that lack healthy foods and places to exercise.

Bedford Stuyvesant and Crown Heights in Brooklyn and Jamaica, Queens have some of the highest maternal mortality rates in the city. The four main causes of death are blood clots, bleeding, high blood pressure and infection -- and women are more at risk of these problems if they are obese. More than half the women who died received prenatal care.

Dr. Marilyn Kacica from the state Health Department says the pregnancy of a woman who is obese needs to be treated as high risk -- "and special considerations need to go into her care, but right now she's being treated just like every other patient."

On top of combating obesity, the New York Academy of Medicine says there are also systemic problems to deal with. The Academy's president, Dr. Jo Ivey Boufford, feels like information from primary care physicians and obstetrician-gynecologists who know a pregnant woman's history is not getting to the hospitals that are treating them when they are in crisis. Plus, Bouffard says, "a lot of emergency rooms, a lot of internists aren't really used to dealing with pregnant women."