Racial and Ethnic Disparities in Maternal and Neonatal Adverse Outcomes in College-Educated Women.

Abstract

To compare composite maternal and neonatal adverse outcomes among women with at least a bachelor's degree by racial and ethnic groups. This was a retrospective cohort study using the U.S. vital statistics data sets. We included women with at least a bachelor's degree who delivered a nonanomalous live singleton neonate at 24-40 weeks. 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. The secondary outcome, composite neonatal adverse outcome, included 5-minute Apgar score less than 5, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Multivariable regression models were used to estimate the association between maternal race and adverse outcomes. Of 11.8 million live births, 2.2 million (19%) met the inclusion criteria; 81.5% were to non-Hispanic white women, 8.5% to non-Hispanic black women, and 10% Hispanic women. The overall rate of composite maternal adverse outcome was 5.3 per 1,000 live births. Compared with non-Hispanic white women, the risk of the composite maternal adverse outcome was significantly higher among non-Hispanic black women (adjusted relative risk [aRR] 1.20; 95% CI 1.13-1.27), but lower among Hispanic women (aRR 0.69; 95% CI 0.64-0.74), a pattern which varied among different gestational age groups. The overall rate of composite neonatal adverse outcome was 11.6 per 1,000 live births. 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. Among women with at least a bachelor's degree, small but measurable racial and ethnic disparities in composite maternal and neonatal adverse outcomes.