Perinatal & Pediatric
Racial Disparities in Maternal Health and Birth Outcomes in Jefferson County, Kentucky 2017-2022 Felicia Pugh, MS* Felicia Pugh Seyed Karimi, PhD Nick Peiper, PhD Kira Taylor, PhD Laura Schummers, ScD Natalie DuPré, ScD
Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities, which interrelated causes may partially explain. This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) in Jefferson County, Kentucky, 2017-2022. We used Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents. We estimated the incidence of each outcome: SMM, stillbirth, pre-term birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) overall and by race. We used logistic regression to estimate odds ratios (ORs) and 95%CIs, comparing the odds of each outcome by race (Black vs. White), adjusted for a set of explanatory variables and pandemic effects. Among 45,646 deliveries, SMM occurred in 8.0 per 1,000 deliveries (95%CI 8.0, 8.1) to White patients and 14.8 per 1,000 (95%CI 14.6, 15.1) to Black patients. The disparity was similar for stillbirth (White 7.2 per 1,000 [95%CI 7.1, 7.2]; Black 12.7 per 1,000 [95%CI 12.5, 13.0]). Among 46,296 births, PTB and SGA occurred in 7.9% (95% CI 7.8, 8.0) and 6.0% (95%CI 5.9, 6.0) of deliveries to White patients, but 11.4% (95%CI 11.2, 11.6) and 13.7% (95%CI 13.5, 14.0) to Black patients. Disparities persisted after adjusting for maternal, infant, and healthcare factors: OR of SMM: 1.5 (95%CI 1.2, 1.9); stillbirth OR 1.4 (95%CI 1.1,1.7); PTB OR 1.4 (95%CI 1.3, 1.5); SGA 2.3 (95%CI 2.1, 2.4) and considering pandemic effects. Findings confirm substantial Black-White disparities in SMM and adverse birth outcomes, highlighting the need to understand the complex relationship of individual characteristics and socioeconomic status. State and local entities can provide a broader understanding of these indicators through Maternal Morbidity Review (MMR) and Fetal Infant Mortality Review (FIMR) committees.
