187 Racial/ethnic disparities in malpresentation at term

Abstract

Malpresentation at term has a multifactorial origin. We set out to explore maternal and perinatal factors associated with malpresentation at term. Retrospective analysis of the Center for Disease Controls’ Natality Live Birth database (2016-2018). The study group was comprised of all term singleton non-cephalic births and cephalic births following a successful external cephalic version (malpresentation group) and was compared to all other cephalic singleton births (control group). Maternal and neonatal characteristics were compared between the two groups using Pearson’s chi-square test with Bonferroni adjustment. Multivariate logistic regression was used to adjust outcomes for potential confounders. Results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI), and statistical significance was set as P value < 0.05. The cohort included 9,692,203 term singleton births, of which, 354,689 (3.7%) were malpresenting. The odds of malpresentation for various maternal and perinatal factors are shown in tables 1 and 2. Non-Hispanic Whites had the highest odds of malpresentation while Non-Hispanic Blacks had the lowest (3.93% versus 2.81%; aOR 1.38, CI 1.36-1.39). Additional factors associated with increased odds include advancing maternal age and nulliparity (aOR 2.81, CI 2.74-2.88, and aOR 1.50, CI 1.48-1.51, for patients >40 years and nulliparous, respectively; Table 1), low birth weight (aOR 1.80, CI 1.77-1.83) and fetal anomalies (aOR 3.53, CI 3.06-4.06, and 2.32, CI 2.05-2.63, for malformations of the central nervous system and chromosomal anomalies; Table 2). To our knowledge, we report for the first time a small but significant racial/ethnic disparity in odds of malpresentation at term in a US population. We also identified several other maternal and perinatal factors increasing the odds of malpresentation at term consistent with prior reports. Our findings provide additional information to better understand malpresentation at term.View Large Image Figure ViewerDownload Hi-res image Download (PPT)