title: Racial and ethnic disparities in maternal morbidity and obstetric care.
abstract: OBJECTIVE
  To evaluate whether racial and ethnic disparities exist in obstetric care and adverse outcomes.
  
  
  METHODS
  We analyzed data from a cohort of women who delivered at 25 hospitals across the United States over a 3-year period. Race and ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, or Asian. Associations between race and ethnicity and severe postpartum hemorrhage, peripartum infection, and severe perineal laceration at spontaneous vaginal delivery as well as between race and ethnicity and obstetric care (eg, episiotomy) relevant to the adverse outcomes were estimated by univariable analysis and multivariable logistic regression.
  
  
  RESULTS
  Of 115,502 studied women, 95% were classified by one of the race and ethnicity categories. Non-Hispanic white women were significantly less likely to experience severe postpartum hemorrhage (1.6% non-Hispanic white compared with 3.0% non-Hispanic black compared with 3.1% Hispanic compared with 2.2% Asian) and peripartum infection (4.1% non-Hispanic white compared with 4.9% non-Hispanic black compared with 6.4% Hispanic compared with 6.2% Asian) than others (P<.001 for both). Severe perineal laceration at spontaneous vaginal delivery was significantly more likely in Asian women (2.5% non-Hispanic white compared with 1.2% non-Hispanic black compared with 1.5% Hispanic compared with 5.5% Asian; P<.001). These disparities persisted in multivariable analysis. Many types of obstetric care examined also were significantly different according to race and ethnicity in both univariable and multivariable analysis. There were no significant interactions between race and ethnicity and hospital of delivery.
  
  
  CONCLUSIONS
  Racial and ethnic disparities exist for multiple adverse obstetric outcomes and types of obstetric care and do not appear to be explained by differences in patient characteristics or by delivery hospital.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; Columbia University, New York, New York; University of Utah Health Sciences Center, Salt Lake City, Utah; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Pittsburgh, Pittsburgh, Pennsylvania; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Texas Medical Branch, Galveston, Texas; Brown University, Providence, Rhode Island; the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; Oregon Health & Science University, Portland, Oregon; the Medical University of South Carolina, Charleston, South Carolina; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
authors.forename: Alan T N
authors.initials: ATN
authors.lastname: Tita
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.forename: J Peter
authors.initials: JP
authors.lastname: VanDorsten
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D022125:Lacerations / Q000208:ethnology* / Q000209:etiology; D010502:Perineum / Q000293:injuries*; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000208:ethnology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult