State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth

Maternal Characteristics and Pregnancy Outcomes Associated with Delivery versus Expectant Management following Decreased Fetal Movement at Term

OBJECTIVE

 This study aimed to compare maternal characteristics and pregnancy outcomes between term patients evaluated for decreased fetal movement (DFM) who were delivered versus expectantly managed.

STUDY DESIGN

 Retrospective cohort study of term patients delivering within a large hospital system from 2015 to 2023 who were evaluated for DFM. Patients were classified into three groups based on the time between evaluation for DFM and delivery admission: (1) <24 hours, (2) 24-48 hours, (3) >48 hours. Bivariate comparisons and multinomial logistic regression were performed to evaluate which maternal characteristics were associated with immediate delivery (<24 and 24-48 hours latency) as compared with expectant management (>48 hours latency) as well as to compare delivery and neonatal outcomes.

RESULTS

 Of 2,015 patients, significant sociodemographic and clinical variations were noted between groups. Following adjustment, noncommercial insurance, hypertension in pregnancy, and body mass index (BMI) ≥30 kg/m2 at delivery were associated with reduced odds of admission <24 and 24-48 hours as compared with >48 hours. There were no cases of stillbirth or neonatal demise and there were no differences in delivery or neonatal outcomes.

CONCLUSION

 Among patients with DFM at term, there are significant sociodemographic and clinical variations between those admitted for <24, 24-48, and >48 hours, though delivery and neonatal outcomes were similar.

KEY POINTS

· Having noncommercial insurance, hypertension in pregnancy, and BMI ≥30 kg/m2 at delivery were associated with reduced odds of admission within <24 and 24-48 hours as compared with >48 hours after presenting with DFM at term.. · There were no cases of stillbirth or neonatal demise among this cohort of patients presenting with DFM at term.. · There were no differences in delivery or neonatal outcomes among this cohort of patients presenting with DFM at term as stratified by timing from presentation to admission for delivery..

Disparities in obstetric sepsis and strategies to prevent them

Severe morbidity and mortality associated with sepsis in obstetric care occur even among those presumed to be at low risk, are highly preventable and deserve critical public health prioritization. Continued research is warranted that focuses on the development and performance assessment of screening tools, standardizing diagnostic criteria, and understanding how to implement and sustain quality improvement practices to support timely recognition and treatment, as well as equitable healthcare practices to improve maternal outcomes across diverse populations.

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

OBJECTIVE

To assess the association between structural racism and labor neuraxial analgesia use.

METHODS

This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black-White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index.

RESULTS

Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9-19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9-29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5-14.4%) in the second tercile and 15.6% (95% CI, 14.7-16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles.

CONCLUSION

A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.