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Sastow DL, Jiang SY, Tangel VE, Matthews KC, Abramovitz SE, Oxford-Horrey CM, White RS. Patient race and racial composition of delivery unit associated with disparities in severe maternal morbidity: a multistate analysis 2007-2014. Int J Obstet Anesth 2021; 47:103160. [PMID: 33931312 DOI: 10.1016/j.ijoa.2021.103160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND High Black-serving delivery units and high hospital safety-net burden have been associated with poorer patient outcomes. We examine these hospital-level factors and their association with severe maternal morbidity (SMM), independently and as effect modifiers of patient-level factors. METHODS Using the 2007-2014 State Inpatient Databases (Florida, New York, California, Maryland, Kentucky), we analyzed delivery hospitalizations. We constructed generalized linear mixed models with patient- and hospital-level variables (Black-serving delivery units: high: top 5th percentile; medium: 5th-25th percentile; low: bottom 75th percentile; hospital safety-net burden status defined by insurance status) and report adjusted odds ratios (aOR) and 99% confidence intervals (CI). We repeated our mixed models with stratification and interaction analysis. RESULTS 6 879 332 delivery hospitalizations were included in the analysis. Deliveries at high (aOR 1.83; 99% CI 1.34 to2.50) or medium (aOR 1.27; 99% CI 1.10 to 1.46) Black-serving delivery units were more likely to have SMM than deliveries at low Black-serving delivery units. Hospital safety-net burden was not significantly associated with SMM. In stratified models by hospital category, deliveries of Black women were associated with an increase in SMM compared with deliveries of White women in all hospital categories. In interaction models, Black women giving birth in high Black-serving delivery units had more than twice the odds of White women in low Black-serving delivery units of experiencing SMM (aOR 2.42; 99% CI 1.90 to 3.08). CONCLUSION The patient racial/ethnic composition of the delivery unit is associated with adjusted-odds of SMM, both independently and interactively with individual patient race.
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Affiliation(s)
- D L Sastow
- Icahn School of Medicine at Mount Sinai, Department of Education, New York, NY, USA
| | - S Y Jiang
- Weill Cornell Medicine, Center for Perioperative Outcomes, Department of Anesthesiology, New York, NY, USA
| | - V E Tangel
- Weill Cornell Medicine, Center for Perioperative Outcomes, Department of Anesthesiology, New York, NY, USA
| | - K C Matthews
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - S E Abramovitz
- Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - C M Oxford-Horrey
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - R S White
- Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA.
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Prabhu M, Cagino K, Matthews KC, Friedlander RL, Glynn SM, Kubiak JM, Yang YJ, Zhao Z, Baergen RN, DiPace JI, Razavi AS, Skupski DW, Snyder JR, Singh HK, Kalish RB, Oxford CM, Riley LE. Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study. BJOG 2020; 127:1548-1556. [PMID: 32633022 PMCID: PMC7361728 DOI: 10.1111/1471-0528.16403] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING Three New York City hospitals. POPULATION Pregnant women >20 weeks of gestation admitted for delivery. METHODS Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). CONCLUSION Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. TWEETABLE ABSTRACT COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.
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Affiliation(s)
- M Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - K Cagino
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - K C Matthews
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | | | - S M Glynn
- Weill Cornell Medicine, New York, NY, USA
| | - J M Kubiak
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Y J Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Z Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - R N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - J I DiPace
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - A S Razavi
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Department of Obstetrics & Gynecology, New York Presbyterian Queens, Queens, NY, USA
| | - D W Skupski
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Department of Obstetrics & Gynecology, New York Presbyterian Queens, Queens, NY, USA
| | - J R Snyder
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Departments of Obstetrics & Gynecology, New York Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - H K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - R B Kalish
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - C M Oxford
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - L E Riley
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
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