Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

Abstract

Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada

“…Neonatal outcomes included low birth weight (LBW) (<2500 g, <1500 g), macrosomia (>4000 g), small- for-gestational-age (SGA) neonates (defined as <10 th percentile of birth weight for gestational age), SGA neonates (<3 rd percentile), large-for-gestational-age (LGA) neonates (defined as >90 th percentile of birth weight for gestational age), 5-min Apgar score (<7, <4), arterial cord pH ≤7.1, hyperbilirubinemia requiring treatment, and neonatal intensive care unit (NICU) admission. We selected these outcomes based on previous research, data availability, sufficient sample size and group discussion in our research team [ 26 ]. These selected outcomes were approved by our internal research protocol review committee and were specified in our protocol for the Research Ethics Board approval.…”

“…Recently, our research group has published three papers on race using Ontario population data [ 26 – 28 ]. We found that compared with White pregnant people, Asian pregnant people had a higher risk of inadequate gestational weight gain (GWG) and a lower risk of excessive GWG in all weight classes, and non-underweight Black pregnant people had a higher risk of inadequate GWG and a lower risk of excessive GWG [ 28 ].…”

“…Our findings also showed that excessive GWG contributed more to LGA neonates than pre-pregnancy obesity in White and Asian people [ 27 ], while there was no difference between excessive GWG and pre-pregnancy obesity in their contributions to the LGA neonates in Black people [ 27 ]. Moreover, our results showed significant differences in the types of adverse perinatal outcomes observed between Asian and White people [ 26 ].…”

The association between striae gravidarum and perineal lacerations during labor

“…Although our study population included Jewish and Bedouin women but not other ethnicities, it could be argued that our conclusion is too generalized. We are well aware of racial and ethnic disparities in adverse perinatal outcomeswe believe that in Israel the situation is different allowing us to make assumptions regarding the generalizability of our findings [ 21 ]. Israel contains a variety of immigrants at various stages of cultural assimilation.…”

Exploring patients' perspectives of gestational diabetes mellitus screening and counselling in Ontario: A grounded theory study

“…Patients who received a GDM diagnosis have reported feelings of self-blame, failure, confusion, and fear, signifying uncertainty and guilt. [14][15][16] Lack of time and continuity of care have been identified as barriers to communication between patients and healthcare providers (HCPs); however, discussion of the GDM condition, associated risks and potential outcomes have been shown to promote greater acceptance of the diagnosis for the patient. 14 Despite evidence indicating patient motivation to protect the health of their baby, many challenges impeding positive behaviour change and treatment compliance have been reported.…”