Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution

Roxanne Mirabal-Beltran, Donna M. Strobino

Research output: Contribution to journalArticle

Abstract

Background: Despite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payor source, provider gender) factors accounted for any observed differences by ethnicity/race. Methods: Our retrospective cohort study used logistic regression to evaluate the relation between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital. Results: Statistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03–6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67–4.81) had higher odds of RCD than White women. Conclusions: Adjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.

Original languageEnglish (US)
JournalWomen's Health Issues
DOIs
StateAccepted/In press - Jan 1 2019

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Hispanic Americans
Parturition
ethnicity
Parity
induction
Vaginal Birth after Cesarean
confidence
Odds Ratio
medical factors
Demography
Confidence Intervals
Induced Labor
Gestational Diabetes
District Hospitals
language education
obstetrics
Marital Status
Public Policy
Health Policy
marital status

ASJC Scopus subject areas

  • Health(social science)
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Maternity and Midwifery

Cite this

Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution. / Mirabal-Beltran, Roxanne; Strobino, Donna M.

In: Women's Health Issues, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Despite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payor source, provider gender) factors accounted for any observed differences by ethnicity/race. Methods: Our retrospective cohort study used logistic regression to evaluate the relation between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital. Results: Statistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95{\%} confidence interval, 1.03–6.01) and Black women (adjusted odds ratio, 2.83; 95{\%} confidence interval, 1.67–4.81) had higher odds of RCD than White women. Conclusions: Adjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.",
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