Racial and ethnic disparities in maternal morbidities and preexisting medical conditions during labor and delivery hospitalizations

Background: Maternal morbidities (MM) and preexisting medical conditions (PMC) during pregnancy are important measures of maternal health. Although mostly preventable, these conditions are increasing and often lead to adverse perinatal outcomes and increased healthcare costs. Objective: To compare MM and PMC during labor and delivery among racial/ethnic groups in Wisconsin. Methods: Retrospective analysis of the 2005-2007 Wisconsin Healthcare Cost and Utilization Project State Inpatient Data (N = 206,428 pregnant women aged 13-44 years). Logistic regression models were estimated for MM and PMC. Covariates included race/ethnicity, maternal age, socioeconomic factors, and comorbidities. Results: About 29% of labor and delivery hospitalizations had ≥1 MM and 8% had ≥1 PMC. For MM, adjusted results show that black women had significantly higher likelihood of infections, preterm labor, antepartum hemorrhage, and hypertension complicating pregnancy compared to white women. Hispanics, Asians and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than whites. Major perineal lacerations were significantly higher among Asians. For PMC, blacks had significantly higher likelihood of asthma, diabetes mellitus, chronic hypertension, and obesity than whites. Diabetes was significantly higher for Hispanics and Native Americans. The likelihood of ≥1 MM was significantly higher for blacks (OR = 1.27; 1.23-1.32), Hispanics (OR = 1.05; 1.01-1.09) and Native Americans (OR = 1.32; 1.20-1.44). Blacks were more likely to have ≥1 PMC (OR = 2.10; 1.99-2.21). Conclusions/Implications: Findings suggest significant racial/ethnic disparities in MM and PMC. Better screening, management and timely referral of these conditions, particularly among racial/ethnic women, should be implemented.