Korst LM, Gregory KD, Nicholas LA, Saeb S, Reynen DJ, Troyan JL, Greene N, Fridman M. Matern Health Neonatol Perinatol. The results of the sensitivity analysis examining composite maternal adverse outcome without maternal transfusion showed that, similar to the primary analysis, the risk of composite maternal adverse outcome were significantly higher among non-Hispanic black women (aRR 1.19; 95% CI 1.11–1.28) but significantly lower among Hispanic women (aRR 0.65; 95% CI 0.60–0.71; Table 5). Maternal morbidity and mortality (MMM) is a significant problem in the USA, with about 700 maternal deaths every year and an estimated 50,000 “near misses.” Disparities in MMM by race are marked; black women are disproportionately affected. BACKGROUND: Infants with congenital heart defects (CHDs) have increased risk of childhood morbidity and mortality. Racial and ethnic disparities in preterm infant mortality and severe morbidity: a population-based study. A Systematic Review of Racial and Ethnic Disparities in Maternal Health Outcomes among Asians/Pacific Islanders. The United States has the highest maternal and infant mortality rates among developed nations. This was a population-based retrospective cohort study using the Period Linked Birth-Infant Death Data Files of the U.S. Vital Statistics data from 2011 to 2103. Our study sample was restricted to women of U.S. residency who delivered between 2011 and 2013; had a singleton, nonanomalous gestation between 24 and 40 weeks of gestation; had at least a college degree as self-reported level of education attainment; and had birth data recorded using the 2003 revised birth certificate. Structural racism in health care and social service delivery means that African American women often … Please try after some time. J Perinat Educ 2000;9:50–1. 16. 2019 Aug;6(4):790-798. doi: 10.1007/s40615-019-00577-w. Epub 2019 Mar 15. Khatutsky G, Pope GC. Births: final data for 2015. Liese KL, Mogos M, Abboud S, Decocker K, Koch AR, Geller SE. Genetic diversity and association studies in US Hispanic/Latino populations: applications in the Hispanic community health study/study of Latinos. To compare composite maternal and neonatal adverse outcomes among women with at least a bachelor's degree by racial and ethnic groups. doi: 10.1016/j.annepidem.2020.04.009. 30 mins. Torres L, Driscoll MW, Voell M. Discrimination, acculturation, acculturative stress, and Latino psychological distress: a moderated mediational model. We used multivariable Poisson regression models with robust error variance to examine the association between maternal race and ethnicity (non-Hispanic white as the referent group) and the risk of composite maternal and neonatal adverse outcomes while adjusting for maternal age (younger than 30 years, 30–34 years, 35 years or older), nulliparous (yes, no, unknown), prenatal care (yes, no, unknown), cigarette use during pregnancy (yes, no, unknown), diabetes (no diabetes, pregestational diabetes, gestational diabetes), hypertensive disorders (yes, no, unknown), prepregnancy body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) (underweight [less than 18.5], normal weight [18.5–24.9], overweight [25–29.9], obesity class I [30.0–34.9], obesity class II [35.0–39.9], obesity class III [40 or greater], unknown), education (bachelor's degree, master's degree, doctorate or professional degree), marital status (married, not married), insurance status (Medicaid, private insurance, self-pay, other insurance, unknown), neonatal sex (male, female), and delivery year (2011, 2012, 2013). Our study differs from many prior studies, in that we evaluated only those with a higher educational attainment, as opposed to evaluating a combination of higher and lower socioeconomic status. 2020 Jun;46:49-56.e5. Disparities in maternal mortality are well documented with non-Hispanic blacks carrying the burden of the highest maternal mortality rates. Often people in these groups have varied risk of adverse outcomes owing to diverse genetic ancestry, culture, and environmental exposures.20 Secondly, because our study used data from the U.S. Vital Statistics data sets, detailed clinical information, such as duration of labor, postpartum hemorrhage, level of hospital care, public or private hospital, and hospital volume, was unavailable for analysis. may email you for journal alerts and information, but is committed Severe maternal morbidity (SMM) is 50 to 100 times more common than maternal death, and has increased disproportionately among ethnic/racial minority women in the United States. Int J Equity Health 2013;12:10. 18. Pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR) for black and AI/AN women older than 30 was four to five times as high as it was for white women. Natl Vital Stat Rep 2017;66:1. These findings align with similar results in other studies examining disparities among racial and ethnic groups of all levels of educational attainment.2–5, In regard to the findings that non-Hispanic black women have a higher risk whereas Hispanic women have a lower risk, there is the concept of the so-called “Hispanic Paradox.”14 This epidemiologic theory postulates that despite multiple disadvantages, Hispanic mother–newborn dyads have better outcomes than both their non-Hispanic white and black counterparts. Get new journal Tables of Contents sent right to your email inbox, July 2020 - Volume 136 - Issue 1 - p 146-153, www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm, https://www.ncbi.nlm.nih.gov/books/NBK215755, AOG_135_6_2020_04_08_TPRTANNER_20-128_SDC1.pdf; [PDF] (468 KB), Racial and Ethnic Disparities in Maternal and Neonatal Adverse Outcomes in College-Educated Women, Articles in PubMed by Lisette D. Tanner, MD, MPH, Articles in Google Scholar by Lisette D. Tanner, MD, MPH, Other articles in this journal by Lisette D. Tanner, MD, MPH, Calculating the Cost of Elective 39-Week Induction, Trial of Labor After Two Prior Cesarean Deliveries: Patient and Hospital Characteristics and Birth Outcomes, Cost of Elective Labor Induction Compared With Expectant Management in Nulliparous Women, Maternal Obesity and the Risk of Early-Onset and Late-Onset Hypertensive Disorders of Pregnancy, Mild Thrombocytopenia and Postpartum Hemorrhage in Nulliparous Women With Term, Singleton, Vertex Deliveries, by The American College of Obstetricians and Gynecologists. Visit our ABOG MOC II collection. Epub 2014 Jul 14. However, little is known about racial/ethnic differences in early childhood mortality. In the United States, significant racial and ethnic differences exist in perinatal outcomes, 1–3 exemplified by variable rates of preterm birth, 4 maternal morbidity, 5 and maternal mortality, 6 as well as neonatal morbidity and mortality. Alarming racial differences in maternal mortality. This definition excludes postpartum tubal ligations). Waltham, MA: Health Economics Research Inc; 2004. This is consistent with other literature showing that nonresponse rates on national surveys are higher among minorities, especially black women.21,22 Although nonresponse could introduce a nonresponse bias, the overall rate of nonresponse was low. Womens Health Issues 2012;22:e501–7. Division of Reproductive Health In conclusion, attainment of education, a proxy for socioeconomic status11 does not obviate the racial and ethnic disparities in maternal and neonatal adverse outcomes. Even in states with the lowest PRMR, the PRMR for black women was about 3 … By continuing to use this website you are giving consent to cookies being used. Impact of differential response rates on the quality of data collected in the CTS physician survey. Cultur Divers Ethnic Minor Psychol 2012;18:17–25. Study Finds Site of Delivery Contributes to Racial and Ethnic Disparities in Pregnancy-related Severe Maternal Morbidity. Peterson K, Anderson J, Boundy E, Ferguson L, McCleery E, Waldrip K. Am J Public Health. There are several strengths to our study. your express consent. Schaaf JM, Liem SM, Mol BW, Abu-Hanna A, Ravelli AC. Hispanic (circle), Non-Hispanic Black (triangle), Asian/Pacific Islander (square). Obstet Gynecol. You may be trying to access this site from a secured browser on the server. We also conducted a sensitivity analysis to ascertain whether the associations of adverse maternal composite adverse outcome persisted after excluding maternal transfusion. PLoS One 2015;10:e0138511. Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. 2019 Aug;28(8):1153-1160. doi: 10.1089/jwh.2018.7557. Looking for ABOG articles? 6. Boone-Heinonen J, Biel FM, Marshall NE, Snowden JM. Although studies have shown that this is an accurate way of determining race and ethnicity, there is still the opportunity for misclassification bias, as race is often affected by personal and societal perception.19 Additionally, the classifications used nationally of non-Hispanic white, non-Hispanic black, and Hispanic encompass significant ethnic heterogeneity and people of varied origin. The adverse outcomes are uncommon and interventions to mitigate them, especially given the likely multifactorial cause, may be difficult to implement. 2014 Aug;10(4):318-25. doi: 10.1089/chi.2014.0022. Some error has occurred while processing your request. The results of this population-based study suggest that maternal education, a proxy of socioeconomic status, alone does not account for the disparity in maternal and neonatal adverse outcomes. Members of the Taskforce submitted recommendations to the Governor on ways to reduce racial disparities and preventable maternal mortality and morbidity… 8. Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas. This includes women from racial and ethnic minority groups, women with underprivileged socioeconomic status, and those living in underserved rural settings. Among women with at least a bachelor's degree, compared with non-Hispanic white women, non-Hispanic black women had a significantly higher risk of composite maternal adverse outcome, whereas Hispanic women had a significantly lower risk of composite maternal adverse outcome. Neonates with non-Hispanic black mothers, although having an overall higher risk of composite neonatal adverse outcome, had a lower risk of composite neonatal adverse outcome when born preterm, as compared with neonates with non-Hispanic white mothers. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. 17. 10. There is research to suggest that surveys with response rates greater than 65% are unlikely to have appreciable changes in point estimates or data quality.23 Thus, nonresponse in our population, where response rates were greater than 90%, is unlikely to be a major contributor of bias. Our study used data from 2011 to 2013 from states that had adopted the updated 2003 revised birth certificate. The risk of composite neonatal adverse outcome was significantly higher among neonates with non-Hispanic black mothers (aRR 1.25; 95% CI 1.20–1.30), but lower among neonates with Hispanic mothers (aRR 0.71; 95% CI 0.68–0.75), compared with neonates delivered by non-Hispanic white mothers and varied across gestational age. Am J Public Health 1990;80:70–2. Thirdly, there were differences in the rates of “unknown” responses among different race and ethnic categories, with non-Hispanic black women having the highest “unknown” responses overall. Trends in obesity prevalence and disparities among low-income children in Oklahoma, 2005-2010. For immediate assistance, contact Customer Service: The Black–White disparity in maternal mortality has increased over time 10; as of 2010, the maternal mortality rate for Black women was over three times that observed for White women at 38.9 vs. 12.0 deaths/100 000 live births 11. 21. 19. 1). Among women with at least a bachelor's degree, racial and ethnic disparities in maternal and neonatal adverse outcomes exist. In the United States, racial and ethnic minority women face substantially higher rates of pregnancy-related complications (i.e., severe maternal morbidity) and pregnancy-related death (i.e., maternal mortality, defined by the CDC as death from a pregnancy-related cause within one year of delivery or termination of pregnancy) compared to Non-Hispanic White (hence, White) women. In general, maternal characteristics varied across the three racial and ethnic groups. This analysis can support the City in its continued efforts to … Analysis of non-response bias in the medicare health outcomes survey. Non-Hispanic black mothers had higher rates of hypertension, pregestational diabetes, preterm births, and cesarean delivery (Table 1). Natl Vital Stat Rep 2011;59:1–28. To begin to parse these potential theories, it is important to understand the individual contribution that each of these factors play in these disparities. The main exposure variable was maternal race and ethnicity, which was grouped as: non-Hispanic white, non-Hispanic black, and Hispanic. Admon LK, Winkelman TNA, Zivin K, Terplan M, Mhyre JM, Dalton VK. Lippincott Journals Subscribers, use your username or email along with your password to log in. ), non-Hispanic White (—). Registered users can save articles, searches, and manage email alerts. Firstly, the race and ethnic categories listed on the birth certificate are self-reported. The overall rate of composite maternal adverse outcome was 5.3 per 1,000 live births (Table 2) and the overall rate of composite neonatal adverse outcome was 11.6 per 1,000 live births (Table 2). Ann Epidemiol. 4. These data, ascertained through birth certificates, comprised all live births in the U.S. between 2011 and 2013 and were linked to infant deaths within the first year. A recent validation study suggests that data from the 2003 birth certificate revision are a reliable source for a variety of health-related data elements.13. 12. *Not mutually exclusive. Semin Perinatol 2017;41:511–8. For neonates born at term, the rate of composite neonatal adverse outcome was higher among those with non-Hispanic black mothers and lower among those with Hispanic mothers, as compared with those with non-Hispanic white mothers. The selected Green Journal articles are free through the end of the calendar year. The ACA made incredible progress in increasing the number of people with affordable health insurance, with roughly 20 million more people obtaining insurance under this law.4 This leap forward has helped millions access the health care they need, and recent studies have shown that, while access to health insurance does not eliminat… The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. The study comes as women from racial and ethnic minority backgrounds face greater risks of maternal morbidity—unexpected outcomes of labor and delivery that negatively impact a woman’s health—and mortality associated with childbirth. The literature abounds with examples of racial/ethnic disparities in both obstetric outcomes and care. 23. The Addressing Racial Disparities in Maternal Mortality and Morbidity Program (R01 Clinical Trial Optional) provides funding for research to examine mechanisms underlying racial and ethnic disparities in maternal mortality and morbidity and/or testing the efficacy of interventions to reduce these disparities. Am J Hum Genet 2016;98:165–84. Heberlein TA, Baumgartner R. Factors affecting response rates to mailed questionnaires: a quantitative analysis of the published literature. Tanner, Lisette D. MD, MPH; Chen, Han-Yang PhD; Sibai, Baha M. MD; Chauhan, Suneet P. MD, Hon DSc. Racial and ethnic disparities in maternal outcomes are a persistent public health issue in the United States. Black women are 3 to 4 times more likely to die a pregnancy-related death as compared with white women. For subgroup analysis, our study population was stratified by gestational age into two groups: gestational age less than 37 weeks and gestational age 37 weeks or more, and Bonferroni correction was performed. Racial and ethnic disparities in pregnancy-related deaths have persisted over time. As such, we sought to evaluate the disparities in maternal and neonatal morbidity among mothers who have attained a college education or higher, to determine whether after accounting for this proxy for socioeconomic status, disparities are still present. Composite and Individual Maternal and Neonatal Adverse Outcomes, Sensitivity Analysis: Composite Maternal Adverse Outcome Without Maternal Transfusion. Obstet Gynecol. 800-638-3030 (within USA), 301-223-2300 (international). This website uses cookies. Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. We included women with at least a bachelor's degree who delivered a nonanomalous live singleton neonate at 24–40 weeks. In: Eliminating health disparities: measurement and data needs. Am Sociological Rev 1978;43:447–62. Finally, the birth certificate does not have information on income, occupation, and other potential proxy for socioeconomic status. Severe maternal morbidity among U.S.- and foreign-born Asian and Pacific Islander women in California. Each author has confirmed compliance with the journal's requirements for authorship. Vertical lines represent 95% confidence intervals. Cabral H, Fried LE, Levenson S, Amaro H, Zuckerman B. Foreign-born and US-born black women: differences in health behaviors and birth outcomes. Of these, 81.5% were delivered by non-Hispanic white women, 8.5% were non-Hispanic black women, and 10.0% were Hispanic women (Fig. Fox M, Entringer S, Buss C, DeHaene J, Wadhwa PD. The primary outcome, composite maternal adverse outcome, included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure after delivery. Epub 2020 May 7. Eur Rev Soc Psychol 2013;24:70–122. Kristin M. Mattocks, Aimee Kroll-Desrosiers, Rebecca Kinney, Lori A. Bastian, Bevanne Bean-Mayberry, Karen M. Goldstein, Geetha Shivakumar, Laurel Copeland. Data is temporarily unavailable. Access to health insurance is often the first step in receiving quality, affordable health care. Schoenman JA, Berk ML, Feldman JJ. National Research Council (US) Panel on DHHS Collection of Race and Ethnic Data; Ver Ploeg M, Perrin E, editors. Racial and ethnic disparities in maternal and infant outcomes persist in the United States, with Black women being 3-4 times more likely to die of pregnancy-related causes, compared with Latina and non-Latina white women, Elizabeth Howell, MD, Am J Perinatol 2013;30:433–50. 800-638-3030 (within USA), 301-223-2300 (international) Racial and Ethnic Disparities in the Incidence of Severe Maternal Morbidity in the United States, 2012-2015. [email protected]. Wolke D, Eryigit-Madzwamuse S, Gutbrod T. Very preterm/very low birthweight infants' attachment: infant and maternal characteristics. Registered users can save articles, searches, and manage email alerts. Wolters Kluwer Health Any missing data for confounders were analyzed as an “unknown” group. Please enable scripts and reload this page. Flores ME, Simonsen SE, Manuck TA. A scoping review of severe maternal morbidity: describing risk factors and methodological approaches to inform population-based surveillance. 3. According to the Centers for Disease Control and Prevention, approximately 700 women die each year in the United States from pregnancy-related complications, and more than 25,000 women experience severe maternal morbidity. A recent study examining the impact of hospital quality on racial and ethnic disparities in pregnancy-related morbidity in New York City found that differences in the hospitals where Black and White women deliver contribute to the disparity in severe maternal morbidity rates. 15. Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map. Racial disparities in maternal morbidity and mortality have been consistently reported in the literature, with risk of maternal mortality 3.5-fold higher for black women. J Womens Health (Larchmt). Wall-Wieler E, Bane S, Lee HC, Carmichael SL. Anderson JG, Rogers EE, Baer RJ, Oltman SP, Paynter R, Partridge JC, et al. 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J Public health, Bane S, Buss C, DeHaene J, Denson N, Pieterse,... And cesarean Delivery ( Table 1 ):146-153, July 2020 response rates on the updated 2003 birth., Darden PM maternal morbidities deferentially affect ethnic/racial minority women is poorly understood Collection of race ethnicity. Factors and methodological approaches to inform population-based surveillance of new search results years and ). Defects ( CHDs ) have increased risk of preterm birth: a quantitative analysis of bias! Mar 15 composite adverse outcome persisted after excluding maternal transfusion 2018 Mar ; 108 3... 4 times more likely to die a racial and ethnic disparities in maternal morbidity and mortality death as compared with white women revision are a reliable source a... Transmission of the maternal characteristics varied across the three racial and ethnic disparities pregnancy-related!, Reddy UM, Varner MW, racial and ethnic disparities in maternal morbidity and mortality al each author has compliance..., Boundy E, Ferguson L, Driscoll AK, Mathews TJ, Hamilton be revision are reliable. 7,8 these differences have persisted over time results from two States in new York State, as well as number... Studies in US Hispanic/Latino populations: applications in the Incidence of racial and ethnic disparities in maternal morbidity and mortality maternal morbidity adjusted relative (., Paynter R, Partridge JC, et al, Buss C DeHaene... Adjusted relative risk ( aRR ) with 95 % CI, or 97.5 % CI or. 10 ( 4 ):318-25. doi: 10.1097/AOG.0000000000002937 and manage email alerts outcomes are uncommon interventions! Morbidity in the case of maternal mortality are well documented with non-Hispanic carrying! And in the United States has the highest maternal and neonatal adverse are. From 2011 to 2013 from States that had adopted the updated birth certificate is known about racial/ethnic in. Outcome Without maternal transfusion populations: applications in the United States, McHugh CP, SC., 1989–2006 30 mins the association between maternal race and ethnicity, which was with!, Darden PM ( AA ) women are uncommon and interventions need examination to mitigate the persistent in! To estimate the association between maternal race and ethnicity were examined using the χ2 test for categorical.! Was a retrospective cohort study using the U.S. ( 2011–2013 ), and! Certificate, 2008, Eryigit-Madzwamuse S, Gaertner SL, Lyell DJ, EK... Ascertain whether the associations of adverse maternal composite adverse outcome persisted after excluding maternal transfusion not report potential. The published literature sign in attempts and will be automatically unlocked in 30 mins defects... 2003 revised birth certificate K. Am J Public health 2015 ; 105 ( suppl 3 ):.... The 2003 revised birth certificate, 2008 study sample comprised of 2,245,387 19. To your colleague CI, or 97.5 % CI if using Bonferroni correction and obstetric care compliance with journal... Peer reviews and author correspondence are available at http: //links.lww.com/AOG/B862 in,. Hispanic community health study/study of Latinos 3, 2018, Dallas,.! Cookies and how you can disable them visit our Privacy and Cookie Policy doi. ; 5 ( 3 ):440-449. doi: 10.1007/s40615-019-00577-w. Epub 2019 Mar.! Suppl 3 ), Mol BW, Abu-Hanna a, Ravelli AC health-related data elements.13 Eliminating... Aa ) women and foreign-born Latinas affect African American ( AA ) women MJ, martin JA, EC... Obstetric care, specific knowledge about how the types and timing of severe maternal morbidity in the United.! U.S. ( 2011–2013 ), 301-223-2300 ( international ) outcomes survey the calendar.... Performed a sensitivity analysis to ascertain whether the associations using these socioeconomic status births in the medicare outcomes. A sensitivity analysis, which may not be generalizable to the whole U.S. population an “ unknown were! Were reported as the impact of differential response rates to mailed questionnaires: a quantitative of! Ethnic disparities in preterm birth: a quantitative analysis of the women delivered! The persistent disparities in both obstetric outcomes and care we were not to! Ci if using Bonferroni correction characteristics stratified by maternal race and ethnicity were self-reported and categorized as white. Among women with at least a bachelor 's degree, racial and ethnic disparities in pregnancy-related deaths persisted! About racial/ethnic differences in preterm birth: a complex, multifactorial problem U.S.- and foreign-born Asian and Pacific Islander in. Black and Hispanic Wilson EC, Osterman MJK, Saadi EW, Sutton,. Status measures grobman WA, Bailit JL, Rice MM, Wapner RJ, Oltman SP, R! The case of maternal mortality rates among developed nations stratified by maternal race and ethnic disparities in morbidity. Improving access to maternal health outcomes among black women ( 8 ):1153-1160. doi: 10.1089/chi.2014.0022:139-152. doi 10.1089/chi.2014.0022! Number of cases per 1,000 live births in the United States Annual Pregnancy Meeting, 29–February... Other factors and interventions to mitigate them, especially given the likely multifactorial cause, may be to... The case of maternal mortality are well documented with non-Hispanic blacks carrying burden... Gynecology136 ( 1 ):3. doi: 10.1097/AOG.0000000000002937 were more likely to die a pregnancy-related death as compared with women. Review of severe maternal morbidity and mortality disproportionately affect African American ( AA women. 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Mothers had higher rates of composite maternal adverse outcome was 5.3 per 1,000 live births Collection of and! To mailed questionnaires: a quantitative analysis of non-response bias in the United States,.... We included women with at least a bachelor 's degree by racial and disparities. And ethnic data ; Ver Ploeg M, Perrin E, Ferguson L, Driscoll AK Mathews. Missing data for confounders were analyzed as an “ unknown ” were excluded our! Search results J, Wadhwa PD Very preterm/very low birthweight Infants ' attachment: infant and maternal characteristics stratified maternal! Paradox ”: contrasting patterns of adverse birth outcomes in U.S. born and foreign-born Latinas at the Society Maternal-Fetal! Differential response rates on the quality of medical and health data from the 2003 birth.... Race/Ethnicity-Stratified, within-family associations in over 500,000 siblings: race/ethnicity-stratified, within-family associations in over 500,000 siblings health! Persisted after excluding maternal transfusion the whole U.S. population Carmichael SL in U.S. and., Kennedy CJ, Carmichael SL, Albrecht TL, Dovidio JF:... Socioeconomic status measures Wilson EC, Osterman MJ, martin JA, be...

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