Racial Disparities in Maternal Blood Transfusion in the United States by Mode of Delivery: A Population-Based Retrospective Cohort Study [ID 2683649

Abstract

INTRODUCTION: Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities within specific interventions and outcomes during childbirth, such as blood transfusion. We aimed to assess racial disparities in maternal blood transfusion in the United States overall and stratified by mode of delivery. METHODS: We performed a population-based retrospective cohort study of term, live births (2016–2021) using U.S. Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% CIs of maternal blood transfusion (during labor or delivery) by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors. RESULTS: The study included 15,936,920 deliveries; maternal blood transfusion occurred in 3.7 per 1,000 deliveries. Compared with White individuals (3.5 per 1,000 transfusion rate), higher odds of transfusion were seen among American Indian and Alaskan Native (AIAN) (aOR 2.31; 95% CI, 2.19–2.44) and Pacific Islander individuals (aOR 1.65; 95% CI, 1.46–1.86). The frequency of transfusion and racial disparities in transfusion rates varied substantially by mode of delivery. For example, among forceps deliveries, compared with White individuals (9.1 per 1,000 transfusion rate), Chinese individuals had a nearly twofold higher rate of transfusion (aOR 1.93; 95% CI, 1.30–2.87), whereas Black individuals had a nearly 30% lower rate (aOR 0.71; 95% CI, 0.56–0.91). CONCLUSION: Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly within AIAN and Pacific Islander individuals, and vary by mode of delivery.