Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term

Jacqueline G. Parchem; Madeline Murguia Rice; William A. Grobman; Jennifer L. Bailit; Ronald J. Wapner; Michelle P. Debbink; John M. Thorp Jr; Steve N. Caritis; Mona Prasad; Alan T.N. Tita; George R. Saade; Yoram Sorokin; Dwight J. Rouse; Jorge E. Tolosa; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

doi:10.1055/s-0041-1730348

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(05): 557-566
DOI: 10.1055/s-0041-1730348

Original Article

Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term

Jacqueline G. Parchem

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, and Children's Memorial Hermann Hospital, Houston, Texas

,

Madeline Murguia Rice

²George Washington University Biostatistics Center, Washington, District of Columbia

,

William A. Grobman

³Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

,

Jennifer L. Bailit

⁴Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio

,

Ronald J. Wapner

⁵Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Michelle P. Debbink

⁶Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

,

John M. Thorp Jr

⁷Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Steve N. Caritis

⁸Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

,

Mona Prasad

⁹Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

Alan T.N. Tita

¹⁰Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

George R. Saade

¹¹Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Yoram Sorokin

¹²Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

,

Dwight J. Rouse

¹³Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island

,

Jorge E. Tolosa

¹⁴Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon

,

for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

› Author Affiliations

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.

Key Points

Term neonates of Black patients have the highest crude frequency of adverse perinatal outcomes.
After adjustment for confounders, higher risk for neonates of Black patients is no longer observed.
Disparities in outcomes are strongly related to insurance status.

Keywords

disparities - neonatal outcome - perinatal outcome - race and ethnicity - term

Full Text

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Supplementary Material

Supplementary Material