Race and obstetrical practices for low-risk nulliparous patients after the ARRIVE trial

Abstract

Overall, labor inductions and 39 week deliveries have been increasing for low-risk, nulliparous patients while cesarean deliveries have been decreasing. These trends were accelerated after the ARRIVE trial publication in 2018. Given that these obstetrical practices are known to vary by race, we wanted to evaluate whether the findings of ARRIVE were applied uniformly among patients of all races. This was a population-based cohort study of low-risk, nulliparous deliveries between 39+0 to 41+6 weeks using US Natality Data. Outcomes were obstetrical practices: labor induction (IOL) and delivery by 39 weeks and cesarean delivery (CD). These were stratified by self-reported race recorded in the dataset. Using multivariate and stratified logistical regression models, we compared the years following ARRIVE (2019-2020) with the three years prior (2015-2017) for changes in the rates of these practices by race. There were 1,804,474 patients with self-reported race in the pre-ARRIVE group and 1,099,027 in the post-ARRIVE group. IOL plus 39 week delivery increased significantly for all races in the post ARRIVE period (Table 1). The rate of IOL plus 39 week delivery remained highest among Blacks in the post ARRIVE period, but the greatest increase was among Whites (+7.1%) and the highest odds was among Asians (aOR 1.70, 95% CI 1.65, 1.76). Though the CD rate remained the lowest for Whites in the post ARRIVE period, there were larger decreases in CD rates among the non-White races (Figure 1). All races appeared to have changes in obstetrical practices after the ARRIVE trial. While the overall rate of IOL plus 39 week delivery was highest among Blacks in both periods, the rate of change was highest among Whites. However, regarding CD rates, the largest changes were seen in non-White groups. Despite persistent racial differences, this data suggests that the changes in obstetrical practices that occurred post-ARRIVE might have helped to close pre-existing racial gaps.View Large Image Figure ViewerDownload Hi-res image Download (PPT)