TY - JOUR
T1 - Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution
AU - Mirabal-Beltran, Roxanne
AU - Strobino, Donna M.
N1 - Funding Information:
Funding: Dr. Mirabal-Beltran was supported in part through the Centers of Excellence in Maternal and Child Health in Education, Science and Practice Program, funded through Maternal and Child Health Bureau at the Health Resources and Services Administration, U.S. Department of Health and Human Services (T76MC00003). Additional support provided by the Sylvia and Eddie Brown Scholars and the American Association of University Women American Fellowship. The funding sources had no involvement in the conduct of the research or the preparation of the article.
Publisher Copyright:
© 2019 Jacobs Institute of Women's Health
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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, payer source, provider gender) factors accounted for any observed differences by ethnicity/race. Methods: Our retrospective cohort study used logistic regression to evaluate the relationship 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.
AB - 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, payer source, provider gender) factors accounted for any observed differences by ethnicity/race. Methods: Our retrospective cohort study used logistic regression to evaluate the relationship 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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U2 - 10.1016/j.whi.2019.09.001
DO - 10.1016/j.whi.2019.09.001
M3 - Article
C2 - 31623931
AN - SCOPUS:85073538906
SN - 1049-3867
VL - 30
SP - 7
EP - 15
JO - Women's Health Issues
JF - Women's Health Issues
IS - 1
ER -