Disparities in maternal outcomes among four ethnic populations

Objective: To examine racial disparities in adverse maternal outcomes among four ethnic groups in the United States. Design, Setting, and Participants: A total of 1,030,350 women aged 13 to 55 who delivered in 1998 and 1999. Data were abstracted from the National Inpatient Sample. Main Outcome Measures: Race was categorized as White, African-American, Hispanic, and Asian/Pacific Islander. Maternal outcome measures included preterm labor, hypertensive disorders of pregnancy, gestational diabetes, antepartum hemorrhage, membrane disorders, cesarean section, and postpartum hemorrhage. Results: African Americans were more likely to have preterm labor (odds ratio [OR] 1.71), pre-eclampsia (OR 1.59), transient hypertension of pregnancy (THP) (OR 1.13), pregnancy-induced hypertension (PIH) (OR 1.38), diabetes (OR 1.26), placenta previa (OR 1.78), placental abruption (OR 1.52), premature rupture of membranes (PRM) (OR 1.19), infection of the amniotic cavity,(IAC) (OR 1.95), and cesarean section (risk ratio [RR] 1.08); Hispanics were more likely to have diabetes (OR 1.44), placenta previa (OR 1.20), IAC (OR 1.15), and cesarean section (RR 1.06); and Asian/Pacific Islanders were more likely to have diabetes (OR 2.05), placenta previa (OR 1.57), PRM (OR 1.26), IAC (1.79), and postpartum hemorrhage (OR 1.19), Conclusions: African Americans had the worst outcomes when adjusted for sociodemographic characteristics and comorbidities. Infection, gestational diabetes, and control of hypertension, especially among African Americans, are the most significant preventable risk factors contributing to disparities. By increasing access to health services, health education, and appropriate perinatal care in minority populations, improvements are likely to occur across multiple measures including frequencies of preterm labor, cesarean section, and gestational diabetes.