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Racial and ethnic disparities in obstetric complications: A retrospective analysis, 2007-2014
Abstract Number: BP-06
Abstract Type: Original Research
Disparities by race and ethnicity in obstetric care and intrapartum complications have been widely documented, though many studies have mostly only provided analyses of unadjusted rates (1,2). We aimed to expand on these analyses by adjusting for potential confounders at the patient and hospital level, in an effort to produce more precise odds of obstetric complications in individual racial and ethnic groups.
Using a sample of 6,911,916 deliveries from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Health Research and Quality for California, Florida, Kentucky, Maryland, and New York from 2007-2014, we analyzed the incidence of the presence of any obstetric complications by race/ethnicity, including: in-hospital mortality, cardiac arrest, intrauterine growth restriction, placental abruption, hospital length of stay greater than or equal to seven days, preterm birth, oligohydramnios, the need for a blood transfusion, stillbirths, premature ruptured membranes, Cesarean delivery, severe preeclampsia or eclampsia, anesthesia complications, cerebrovascular complications, sepsis or shock, and postpartum hemorrhage. We additionally analyzed complications individually if they had a prevalence greater than 1% in the entire dataset. Multivariate logistic regression models were fit for all outcomes, controlling for fixed patient comorbidities specific to an obstetric population and demographics (insurance payer, age, income status) and hospital characteristics (year of admission, state, delivery volume). Delivery type (vaginal, operative vaginal, or Cesarean) was included as an additional covariate in appropriate models.
In adjusted analyses, black women were 16% more likely to experience any obstetric complication (aOR: 1.16, 95% CI: 1.15-1.17, p < 0.001), 26% more likely to have a placental abruption, 71% more likely to have a length of stay longer than 7 days, 34% more likely to develop oligohydramnios, 79% more likely to receive a blood transfusion (controlling for surgery type), 85% more likely to have a stillborn baby, 10% more likely to have membranes rupture prematurely, and 9% more likely to experience postpartum hemorrhage (regardless of surgery type), each as compared to white women.
While controlling for patient and hospital-level factors, black women are more likely to experience obstetric complications than white women. Provider education about the history of maternal health disparities, education to reduce implicit bias, and training to improve communication with patients are some actions that can be taken within hospitals to ameliorate racial and ethnic disparities in obstetrics and improve maternal outcomes.
 Creanga AA, et al. Obstet Gynecol. 2012;120(2):261-268
 Berg CJ, et al. Obstet Gynecol. 2010;116(6):1302-1309