Trends in Cesarean Delivery by Race and Ethnicity Among Women With Advanced Maternal Age, 2014–2018 [A148

Abstract

INTRODUCTION: There has been an overall decrease of cesarean deliveries in the United States over recent years. We sought to determine if this trend was consistent in the advanced maternal age (AMA) population, and if there were disparities based on maternal race and ethnicity. METHODS: This was a retrospective cohort study including singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Our study included repeat cesarean delivery. Analyses were stratified by maternal race/ethnicity, including non- Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the fraction of births cesarean delivery. Confounders assessed included diabetes status, prior cesarean delivery, age, parity, BMI, cigarette use, educational attainment, and insurance type. RESULTS: There were 3,094,296 births included in this study. Black women had the highest probability of cesarean delivery from 2014 to 2018. Non-Hispanic AI/AN women had the lowest probability. The predicted probability of cesarean delivery was lower in 2018 than 2014 for all maternal race and ethnicity groups. The largest decline was seen in Black women, decreasing from 45.5% to 43.8% from 2014 to 2018. CONCLUSION: Cesarean deliveries are decreasing among all pregnant women with AMA. However, there are disparities in this outcome when accounting for maternal race and ethnicity, with Black women most at risk.