Racial/Ethnic Disparities in Maternal Morbidities: A Statewide Study of Labor and Delivery Hospitalizations in Wisconsin

We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital
discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged
13–53 years using 2005–2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After
adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational
diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression
models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional
odds models. African–Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60–1.89), preterm labor
(OR = 1.42; 1.33–1.50), antepartum hemorrhage (OR = 1.63; 1.44–1.83), and hypertension complicating pregnancy (OR = 1.39;
1.31–1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood
of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly
higher among Asian/Pacific Islanders (OR = 1.53; 1.34–1.75). All minority racial/ethnic groups, except Asians, had significantly
higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women.
Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely
referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant
mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.