Abstract
Objective Non-Hispanic black and Hispanic women experience significantly higher adverse maternal
and neonatal outcomes compared with non-Hispanic white women. The purpose of this
study is to explore whether disparities in obstetric outcomes exist by race among
women who are college-educated.
Study Design This is a retrospective cohort study from a multicenter observational cohort of women
undergoing cesarean delivery. Women were defined as “college-educated” if they reported
completion of a 4-year college degree. Race/ethnicity was categorized as non-Hispanic
white, non-Hispanic black, Hispanic, Asian, Native American, or unknown. The primary
outcome was a composite of maternal morbidity, and a composite of neonatal morbidity
was evaluated as a secondary outcome. A multivariable logistic regression model was
then utilized to assess associations of race with the primary and secondary outcomes.
Results A total of 2,540 women were included in the study. After adjusting for potential
confounding variables, maternal morbidity was found to be significantly higher for
college-educated non-Hispanic black women compared with non-Hispanic white women (odds
ratio [OR] 1.77, 95% confidence interval [CI] 1.12–2.80). The incidence of neonatal
morbidity was significantly higher for non-Hispanic black (OR 1.91, 95% CI 1.31–2.79)
and Hispanic (OR 3.34, 95% CI 2.23–5.01) women.
Conclusion In this cohort, the odds of cesarean-related maternal and neonatal morbidities were
significantly higher for college-educated non-Hispanic black women, compared with
their non-Hispanic white counterparts. This demonstrates that even among women with
higher level education, racial and ethnic disparities persist in obstetric outcomes.
Keywords
racial disparities - maternal morbidity - neonatal morbidity - education
