In a study to be presented on February 14 between 1:15 p.m., and 3:30 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, California, researchers will present data showing racial and ethnic disparities exist for adverse obstetric outcomes.
In his study Dr. William Grobman of Northwestern University, presenting for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, studied 115,502 women over a three year period to see if adverse obstetric outcomes and provisions in obstetric care were affected by race or ethnicity. The study encompassed 25 hospitals and data on deliveries was gathered on 365 randomly selected days. Race and ethnicity were categorized as Non-Hispanic White (52,040), Non-Hispanic Black (23,878), Hispanic (27,291) or Asian (5,999).
Dr. Grobman then looked at associations between race/ethnicity and post-partum hemorrhage, peripartum infection, and severe perineal laceration; these were controlled for demographic differences between racial/ethnic groups and for hospital of delivery. Associations between race/ethnicity and types of obstetric care were also considered.
According to his findings, NHW women were least likely to experience postpartum hemorrhage or peripartum infection, and NHB women were least likely to experience severe perineal laceration. Dr. Grobman found these differences held after controlling for demographic characteristics and hospital of delivery.
“The key thing is there are differences in outcomes related to race or ethnicity not explained by patient characteristics or hospital,” said Dr. Grobman. “There are also racial/ethnic disparities in types of intrapartum care that patients receive.”
Aspects of care considered during the study included cesarean delivery, labor induction, dilation at admission, length of pushing, and maximum dose of oxytocin.
Abstract 32: Racial and ethnic disparities in adverse obstetric outcomes and in the provision of obstetric care
OBJECTIVE: To evaluate whether racial/ethnic disparities exist in adverse obstetric outcomes and in the provision of obstetric care, and if so, whether these disparities are explained by differences in patient or hospital characteristics.
STUDY DESIGN: We analyzed data abstracted concurrently from deliveries on 365 randomly selected days at 25 hospitals over a 3-year period. Race/ethnicity was categorized as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, or Asian. Associations between race/ethnicity and postpartum hemorrhage (PPH), peripartum infection (INF), and severe perineal laceration (LAC) at SVD were estimated by univariable analysis, and after controlling for demographic differences among racial/ethnic groups and for hospital of delivery in ﬁxed effects logistic regressions. Similarly, associations between race/ethnicity and types of obstetric care (eg, episiotomy) relevant to the adverse outcomes were compared in both univariable and multivariable analyses.
RESULTS: Of 115,502 studied women, 95% were classiﬁed according to one of the deﬁned race/ethnicity categories. Disparities for all outcomes were observed, with NHW women least likely to experience PPH or INF, and NHB women least likely to experience LAC (Table, P < 0.001 for all). These disparities persisted after controlling for differences in demographic characteristics as well as hospital of delivery. Every aspect of obstetric care that was examined also was signiﬁcantly different according to race/ethnicity (Table, P < .001 for all), even after controlling for demographic characteristics and hospital of delivery. There were no signiﬁcant interactions between race/ethnicity and hospital of delivery.
CONCLUSION: Racial/ethnic disparities exist for adverse obstetric outcomes and in the provision of obstetric care, and do not appear to be explained by differences in demographic characteristics or by delivery hospital.
Dr. Grobman performed this study for the Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.
1Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed.