(1105) Maternal characteristics associated with neuraxial anesthesia use in term, nulliparous, singleton, vaginal deliveries

To evaluate the association between maternal sociodemographic characteristics and the prevalence of neuraxial anesthesia (NA, i.e. epidural or spinal) use in term, nulliparous, singleton, vaginal deliveries (TNS-VDs).

Study Design: Retrospective cohort study utilizing the United States (US) Natality Live Birth database from the Centers for Disease Control and Prevention (2016-2019). All TNS-VDs were included. Operative vaginal deliveries and cases with missing data were excluded. The prevalence of multiple maternal sociodemographic characteristics was compared between two groups using Chi-squared test: patients who had NA vs. those who did not. Multivariable logistic regression was performed to to evaluate the association of these characteristics with NA use. Data were displayed as adjusted odds ratios (aOR) with 95% confidence intervals (CI), and statistical significance was set at P < 0.05.

Results: Of the 3,399,682 births included, 2,697,064 (79.3%) had neuraxial anesthesia during labor. Young maternal age and tobacco use were associated with a higher prevalence of NA use, while lower education level, Medicaid insurance, self-pay, and late prenatal care were associated with a lower likelihood of NA use during labor (Table). Hispanic and non-Hispanic black race/ethnicity, as well as multiracial patients, also had lower likelihoods of NA during labor compared to non-Hispanic white patients (Table).

Conclusion: The prevalence of NA in the US is high, occurring in 4 of 5 TNS-VDs. We detected a number of sociodemographic factors associated with change in the use of NA. More specifically, young maternal age and tobacco use were associated with increased NA use, while patients with lower educational levels, Medicaid insurance, self-pay, late to prenatal care, or of Hispanic and non-Hispanic black race/ethnicity had lower NA use. Research efforts aimed at determining the underlying reasons for this disparity are needed.