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Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term

Citation

Parchem, Jacqueline G.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Debbink, Michelle P.; Thorp, John M., Jr.; Caritis, Steve N.; Prasad, Mona; & Tita, Alan T. N., et al. (Online ahead of print). Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term. American Journal of Perinatology.

Abstract

OBJECTIVE: This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term.
STUDY DESIGN: We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008-2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic-ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy.
RESULTS: Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04-1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71-0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94-1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81-1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75-0.96 for Black; aRR = 0.68, 95% CI: 0.59-0.78 for Hispanic).
CONCLUSION: Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities.

URL

http://dx.doi.org/10.1055/s-0041-1730348

Reference Type

Journal Article

Article Type

Regular

Year Published

Online ahead of print

Journal Title

American Journal of Perinatology

Author(s)

Parchem, Jacqueline G.
Rice, Madeline Murguia
Grobman, William A.
Bailit, Jennifer L.
Wapner, Ronald J.
Debbink, Michelle P.
Thorp, John M., Jr.
Caritis, Steve N.
Prasad, Mona
Tita, Alan T. N.
Saade, George R.
Sorokin, Yoram
Rouse, Dwight J.
Tolosa, Jorge E.