Abstract
INTRODUCTION: Cesarean delivery (CD) rates differ between non-Hispanic White (NHW) and Hispanic/non-White (H/NW) patients, although the relationship varies by indication. We examined CD rates among NHW and H/NW patients in pregnancies complicated by fetal growth restriction (FGR). METHODS: This was an IRB-approved secondary analysis of a retrospective cohort of singleton live births 2003–2012 with an estimated fetal weight (EFW) less than 10th centile for gestational age on the last ultrasound prior to delivery. RESULTS: Of 563 pregnancies, 270 (46.88%) were to NHW patients and 306 (53.12%) to H/NW patients. NHW were older (27.92 versus 26.04 years), taller (160.42 versus 158.58 cm), and more likely to have private insurance (51.30% versus 20.26%) and be admitted to a private practice (70.00% versus 44.41%) (P<.01 for all). There was no difference in umbilical artery Doppler findings, EFW, proportion of CD performed because of nonreassuring fetal status, maternal body mass index, gestational age at FGR diagnosis or delivery, or maternal comorbidities. Apgar scores, arterial cord pH, neonatal intensive care unit admission, hypoglycemia, need for respiratory support, and neonatal death were similar (P>.05 for all). However, NHW patients were more likely to undergo CD (35.71% versus 22.90%, P<.01) including prelabor cesarean (21.48% versus 13.75%, P<.01). After adjusting for maternal age, height, insurance status, and delivering team, risk of CD remained higher among NHW patients (relative risk 1.56, 95% CI 1.20–2.03; adjusted relative risk 1.48, 95% CI 1.12–1.96). CONCLUSION: Despite similar neonatal outcomes, NHW are more likely than H/NW patients to deliver by CD, particularly prelabor CD, when the EFW is below the 10th centile.
Published Version
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