Booker WA, et al. - Researchers sought to assess the correlation of race with adverse maternal outcomes and risk for women aged 40 years or older. Findings revealed an increased risk for adverse outcomes and severe morbidity among black women older than 40 years, however, this differential was of smaller magnitude than reported mortality risk.

Methods

• Researchers used the Nationwide Inpatient Sample for the years 1998–2014 to perform this retrospective cohort study.
• Inclusion of women aged 40–54 years was performed.
• They categorized race and ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown.
• Evaluation of temporal trends in severe maternal morbidity and overall comorbid risk by race in women aged 40 years or older was performed as the evaluation was performed for common pregnancy complications including preeclampsia, gestational diabetes, and cesarean delivery.
• They created adjusted models to determine factors associated with severe morbidity.

Results

• This analysis included a total of 1,724,694 deliveries.
• Over the study period, increase in severe maternal morbidity was observed from 1.6% in 1998–2000 to 3.0% from 2013 to 2014.
• Severe morbidity was observed to be highest among black women at both the beginning (2.4% in 1998–2000) and the end (4.9% in 2013–2014) of the study period.
• Comorbid risk increased overall and individually by race, based on medical conditions and other factors, during this same period.
• The absolute largest increase in risk for acute renal failure, disseminated intravascular coagulation, transfusion, and hysterectomy was observed among black women from 1998–2003 to 2010–2014.
• Black, white, and Hispanic women displayed pregnancy complications including preeclampsia, cesarean delivery, and gestational diabetes more commonly at the end compared with the beginning of the study.
• For overall severe morbidity, the adjusted risk ratio for black compared with white race was 1.81 (95% CI 1.76–1.87).
• A substantially higher risk of death was noted for black women than white women (risk ratio 4.71, 95% CI 3.36–6.61); Hispanic women had more than twice the risk of death (risk ratio 2.13, 95% CI 1.48–3.07) as white women.