Racial Differences in Activity Restriction Recommendations in Pregnancy [ID: 1379637]

Abstract

INTRODUCTION:Activity restriction (AR) is commonly recommended to pregnant patients despite lack of evidence demonstrating benefit to this practice. We describe AR recommendation patterns and identify factors associated with a higher likelihood of recommendation for AR.METHODS:This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Data were collected on nulliparous singletons at eight sites from September 2010 to September 2013. Patients were surveyed about AR recommendations at 22 weeks 0 days–29 weeks 6 days and delivery. We excluded patients missing data on AR and age. Patients were grouped by history of AR in pregnancy. We assessed characteristics between groups using χ2 and Wilcoxon rank sum tests. Associations between AR and demographic and clinical factors were examined with univariable and multivariable logistic regression.RESULTS:Of 9,312 women, 1,386 (14.9%) were recommended AR. In unadjusted analysis, prevalence of race and ethnicity, obesity, chronic hypertension, renal disease, and short cervix were significantly different between groups. After adjustment for covariates, Black and Hispanic patients were less likely to be placed on AR when compared to White patients (adjusted odds ratio [aOR] 0.81 [95% CI 0.68–0.98], and aOR 0.73 [95% CI 0.61–0.87], respectively).CONCLUSION:Activity restriction was more likely to be recommended in patients with obesity, chronic medical conditions, and short cervix. After adjustment for baseline differences, Black and Hispanic patients were significantly less likely to be recommended AR compared to White patients. While AR is not an evidence-based practice, these findings suggest implicit bias may affect which patients receive advice to limit activity in pregnancy.