title: Maternal differences and birth outcome disparities: Diversity within a high risk prenatal clinic.
abstract: BACKGROUND
  We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups.
  
  
  METHODS
  Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes.
  
  
  RESULTS
  Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p < .001), gravidity (p < .001), parity (p = .005), appointment attendance (p < .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p < .001), smoking (p < .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p < .001) compared to Whites.
  
  
  CONCLUSIONS
  Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups.
authors.affiliation: UCSF Department of Psychiatry.
authors.forename: Melanie
authors.initials: M
authors.lastname: Thomas
authors.affiliation: UCSF Department of Psychiatry.
authors.forename: Anna
authors.initials: A
authors.lastname: Spielvogel
authors.affiliation: UCSF Department of Psychiatry.
authors.forename: Frances
authors.initials: F
authors.lastname: Cohen
authors.affiliation: UCSF Department of Pediatrics.
authors.forename: Susan
authors.initials: S
authors.lastname: Fisher-Owens
authors.affiliation: UCSF Department of Obstetrics and Gynecology.
authors.forename: Naomi
authors.initials: N
authors.lastname: Stotland
authors.affiliation: UCSF Department of Psychiatry.
authors.forename: Betsy
authors.initials: B
authors.lastname: Wolfe
authors.affiliation: UCSF Department of Psychiatry.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
keywords: birth outcomes; maternal health; mental health; pregnancy; racial/ethnic disparities