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Association between weighted adverse outcome score and race/ethnicity in women and neonates

Journal of Perinatology volume 41, pages 2730–2735 (2021)Cite this article

Subjects

Abstract

Objective

To examine the association between the Weighted Adverse Outcome Score (WAOS) and race/ethnicity among a large and diverse population-based cohort of women and neonates in the United States.

Study design

This was a retrospective cohort study of women who delivered in the United States between 2011 and 2013. We identified mother-infant pairs with adverse maternal and/or neonatal outcomes. These outcomes were assigned weighted scores to account for relative severity. The association between race/ethnicity and WAOS was examined using chi-square test and multivariable logistic regression.

Results

Compared to White women and their neonates, Black women and their neonates were at higher odds of an adverse outcome.

Conclusion(s)

The vast majority of women and neonates had no adverse outcome. However, Black women and their neonates were found to have a higher WAOS. This tool could be used to designate hospitals or regions with higher-than-expected adverse outcomes and target them for intervention.

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Fig. 1: Weighted Adverse Outcome Score Breakdown.

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References

  1. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94:666–8.

    PubMed  PubMed Central  Google Scholar 

  2. Woolf SH, Aron LY. The US health disadvantage relative to other high-income countries: findings from a National Research Council/Institute of Medicine report. JAMA 2013;309:771–2.

    Article  CAS  Google Scholar 

  3. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010;202:335–43.

    Article  Google Scholar 

  4. ACOG Committee Opinion No. 649. Racial and ethnic disparities in obstetrics and gynecology. Obstet Gynecol. 2015;126:e130–4.

    Article  Google Scholar 

  5. Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol. 2012;36:2–6.

    Article  Google Scholar 

  6. Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital- Stat Rep. 2015;64:1–30.

    CAS  PubMed  Google Scholar 

  7. Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, et al. Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol. 2015;125:1460–7.

    Article  Google Scholar 

  8. Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol. 2007;109:48–55.

    Article  Google Scholar 

  9. Mann S, Pratt S, Gluck P, Nielsen P, Risser D, Greenberg P, et al. Assessing quality obstetrical care: development of standardized measures. Jt Comm J Qual Patient Saf 2006;32:497–505.

    PubMed  Google Scholar 

  10. Pettker CM, Thung SF, Norwitz ER, Buhimschi CS, Raab CA, Copel JA, et al. Impact of a comprehensive patient safety strategy on obstetric adverse events. Am J Obstet Gynecol 2009;200:492 e1–8.

    Article  Google Scholar 

  11. Foglia LM, Nielsen PE, Hemann EA, Walker S, Pates JA, Napolitano PG, et al. Accuracy of the adverse outcome index: an obstetrical quality measure. Jt Comm J Qual Patient Saf 2015;41:370–7.

    PubMed  Google Scholar 

  12. Tolcher MC, Torbenson VE, Weaver AL, McGree ME, El-Nashar SA, Nesbitt KM, et al. Impact of a labor and delivery safety bundle on a modified adverse outcomes index. Am J Obstet Gynecol 2016;214:401 e1–9.

    Article  Google Scholar 

  13. Nicholson JM, Parry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial. Am J Obstet Gynecol 2008;198:511 e1–15.

    Article  Google Scholar 

  14. Davis NL SA, Goodman DA. Pregnancy-related deaths: data from 14 U.S. maternal mortality review committees, 2008–2017. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. 2019.

  15. National Center for Health Statistics. Guide to completing the facility worksheets for the Certificate of Live Birth and Report of Fetal Death (2003 revision). 2016 update. 2006 [Available from: https://www.cdc.gov/nchs/data/dvs/guidetocompletefacilitywks.pdf.

  16. Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial disparities in prematurity persist among women of high socioeconomic status. Am J Obstet Gynecol MFM. 2020;2:100104.

  17. Hutcheon JA, Bodnar LM, Platt RW. Using perinatal morbidity scoring tools as a primary study outcome. J Epidemiol Community Health 2017;71:1090–3.

    Article  Google Scholar 

  18. Willis E, McManus P, Magallanes N, Johnson S, Majnik A. Conquering racial disparities in perinatal outcomes. Clin Perinatol. 2014;41:847–75.

    Article  Google Scholar 

  19. Ely DM, Driscoll AK, Matthews TJ. Infant mortality by age at death in the United States, 2016. NCHS Data Brief. 2018;(326):1–8. PMID: 30475688.

  20. Bingham D, Jones DK, Howell EA. Quality improvement approach to eliminate disparities in perinatal morbidity and mortality. Obstet Gynecol Clin North Am. 2019;46:227–38.

    Article  Google Scholar 

  21. Howell EA, Zeitlin J, Hebert P, Balbierz A, Egorova N. Paradoxical trends and racial differences in obstetric quality and neonatal and maternal mortality. Obstet Gynecol. 2013;121:1201–8.

    Article  CAS  Google Scholar 

  22. ACOG SMFM, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016;215:B17–22.

    Article  Google Scholar 

  23. Zhang JW, Branch W, Hoffman M, De Jonge A, Li SH, Troendle J, et al. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study. BMJ Open. 2018;8:e021670.

    Article  Google Scholar 

  24. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Mathews TJ. Births: final data for 2011. Natl Vital- Stat Rep. 2013;62:1–69, 72.

    PubMed  Google Scholar 

  25. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2012. Natl Vital- Stat Rep. 2013;62:1–68.

    PubMed  Google Scholar 

  26. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital- Stat Rep. 2015;64:1–65.

    PubMed  Google Scholar 

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Funding

LMY was supported by the NICHD K12 HD050121-11 at the time of the study.

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, US

    Saba H. Berhie & Lynn M. Yee

  2. Division of Maternal-Fetal Medicine, California Pacific Medical Center, San Francisco, CA, US

    Yvonne W. Cheng

  3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, US

    Aaron B. Caughey

Authors
  1. Saba H. Berhie
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  2. Yvonne W. Cheng
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  3. Aaron B. Caughey
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  4. Lynn M. Yee
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Contributions

SB and LY designed the analysis and wrote the paper, YC designed and performed the analysis, AC designed the analysis and assisted in writing the paper.

Corresponding author

Correspondence to Saba H. Berhie.

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The authors declare no competing interests.

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Berhie, S.H., Cheng, Y.W., Caughey, A.B. et al. Association between weighted adverse outcome score and race/ethnicity in women and neonates. J Perinatol 41, 2730–2735 (2021). https://doi.org/10.1038/s41372-021-01237-w

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