Category: Labor
Poster Session I
To evaluate racial and ethnic disparities in induction of labor (IOL) rates among low-risk nulliparas in the 39th week of pregnancy and cesarean delivery (CD) rates in this group.
Study Design:
Data was collected from 2020 U.S. Vital Statistics birth certificates. “Low-risk” nulliparas at 39-42 weeks gestation were included. “Low-risk” births were defined as those to patients without gestational or pre-gestational diabetes, chronic hypertension, or hypertensive disorders of pregnancy whose neonate was a vertex-presenting, non-anomalous singleton with birthweight 2500 to 5000 grams. Race and ethnicity groups were defined as Asian, Black, Hispanic White (HW), and non-Hispanic White (NHW) by self-report, other races and ethnicities were excluded as represented < 2% each of population. Statistical comparison was performed with Chi-squared and multivariable logistic regressions controlling for maternal age, BMI, education attainment, public insurance, and marital status. P-values < 0.05 were considered statistically significant.
Results:
Of 675,982 included births, 388,997 (57.6%) were to NHW, 142,910 (21.1%) HW, and 92,730 (13.7%) Black, and 51,345 (7.6%) Asian people. Rates of IOL at 39-weeks were significantly lower in Asian, Black, and HW populations compared to NHW (13.0%, 15.8%, 13.1%, 16.6% respectively, p < 0.0001). Models showed decreased adjusted odds of 39-week IOL among Asian, Black, and HW compared to NHW (Table). CD rates were significantly higher in Asian, Black, and HW populations when compared to NHW (27.0%, 28.8%, 24.3% and 23.1% respectively, p< 0.0001), adjusted odds ratios shown in the table.
Conclusion:
Among low-risk nulliparas in the US, induction of labor at 39-weeks is significantly less common and cesarean delivery significantly more common in Asian, Black, and Hispanic White populations than non-Hispanic White, even when controlling for other socioeconomic factors. Further research should be conducted to evaluate if IOL differences stem from patient or provider factors and if reducing the disparity in low-risk 39-week IOL could alleviate a portion of the disparity in CD rate.
Rachel L. Wood, MD (she/her/hers)
Maternal Fetal Medicine Fellow
Brigham and Women's Hospital
Boston, Massachusetts, United States
Taniya Walker, MD
Brigham and Women's Hospital
Boston, Massachusetts, United States
Taylor S. Freret, MD
Massachusetts General Hospital, Department of Obstetrics and Gynecology
Boston, Massachusetts, United States
Mark A. Clapp, MD, MPH (he/him/his)
Massachusetts General Hospital, Department of Obstetrics and Gynecology
Boston, Massachusetts, United States
Sarah E. Little, MD, MPH
Brigham and Women's Hospital
Boston, Massachusetts, United States