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To evaluate obstetric risk factors and disparities in maternal outcomes in racial minorities compared to the white population.
Retrospective cohort study using data from a multicenter quality improvement program based in Washington State. The study cohort was restricted to singleton deliveries at 22-42 weeks’ gestation between Jan 1, 2011 and Dec 31, 2016 at 12 centers and during time periods where data met strict quality criteria. Selected obstetric risk factors were evaluated in five minority groups (African American, Asian, Native American-Alaskan Native, and Native Hawaiian-Pacific Islander) compared to the non-Hispanic white population. Risk factors included nulliparity, maternal age >35, body mass index >30, incomplete prenatal care, gestational diabetes, and gestational hypertension / pre-eclampsia. Selected maternal outcomes were compared between each minority group and the white population. Outcomes are presented as odds ratios with 95% confidence intervals adjusted for parity, advanced maternal age, obesity, gestational hypertension/pre-eclampsia, gestational diabetes, and incomplete prenatal care.
The study cohort included 15,530 births: 11,087 white, 3156 Asians, 686 African Americans, 383 Native American-Alaskan Natives, and 218 Native Hawaiian-Pacific Islanders. Risk factors differed between racial groups. Compared to the white population, incomplete prenatal care was more common in African Americans (10.3% vs 2.1%; p<0.01) and Native American-Alaskan Natives (12.0% vs 2.1%; p<0.01), Asians had a higher rate of gestational diabetes (18.7% vs 8.7%; p<0.01), and Native Hawaiian-Pacific Islanders were more likely to have a BMI >30 (71.6% vs 53.9%; p<0.01). After adjusting for risk factors, Asians had similar outcomes to the white population. All other minority groups were more likely to have postpartum complications and to leave hospital not exclusively breastfeeding (Table 1). Postpartum hemorrhage was more common in Native American-Alaskan Natives and Native Hawaiian-Pacific Islanders.