Racial/Ethnic Disparities in Maternal Morbidities: A Statewide Study of Labor and Delivery Hospitalizations in Wisconsin

Abstract

We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.

Are Asian American women at higher risk of severe perineal lacerations?

“…Still others suggested the primary cause of the racially based differences in clinical outcomes arises from connective tissue differences. Previous studies have shown that African American women are protected [8,12,13] from developing severe lacerations, and our data corroborate these findings.…”

Pregnancy, parturition and preeclampsia in women of African ancestry

“…Similar findings were made in a large Wisconsin study recruited from hospital discharge data. AA women had the highest risk for all the different types of preeclampsia when compared with European American women 27 . Several other studies looking at risk factors for both eclampsia and preeclampsia in nulliparous and parous women have also shown AA are at higher risk (Table 2).…”

Adaptation of the inflammatory immune response across pregnancy and postpartum in Black and White women

“…The role of race is of interest given considerable racial disparities in risk for adverse birth outcomes; in the US, Black women show 1.3 to 1.5-fold higher risk than Whites for adverse outcomes including gestational hypertension and preterm birth (Hamilton et al 2015, Ghosh et al 2014, Cabacungan, Ngui & McGinley 2012). These outcomes have been linked with dysregulation of inflammatory processes (Kuklina, Ayala & Callaghan 2009, Reddy et al 2015, Behrman, Stith Butler 2007, Mendola et al 2015, Hamilton et al 2015).…”