The association of race and ethnicity on obstetric patients' COVID-19 outcomes: A summary of current literature.

Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, evidence suggests racial and ethnic disparities in COVID-19-related outcomes. Given these disparities, it is important to understand how such patterns may translate to high-risk cohorts, including obstetric patients. A PubMed search was performed to identify studies assessing pregnancy, neonatal, and other health-related complications by race or ethnicity in obstetric patients with COVID-19 infection. Forty articles were included in our analysis based on novelty, relevance, and redundancy. These articles revealed that Black and Hispanic obstetric patients present an increased risk for SARS-CoV-2 infection and maternal mortality; racial and ethnic minority patients, particularly those of Black and Asian backgrounds, are at increased risk for hospitalization and ICU admission; racial and ethnic minority groups, in particular Black patients, have an increased risk for mechanical ventilation; Black and Hispanic patients are more likely to experience dyspnea; Hispanic patients showed higher rates of pneumonia; and Black patients present an increased risk of acute respiratory distress syndrome (ARDS). There is conflicting literature on the relationship between race and ethnicity and various pregnancy and neonatal outcomes. Several factors may underly the racial and ethnic disparities observed in the obstetric population, including biological mechanisms and social determinants of health.

Obstetric and perinatal racial and ethnic disparities.

PURPOSE OF REVIEW: Healthcare disparities are health differences that adversely affect disadvantaged populations. In the United States, research shows that women of color, in particular Black and Hispanic women and their offspring, experience disproportionately higher mortality, severe maternal morbidity, and neonatal morbidity and mortality. This review highlights recent population health sciences and comparative effectiveness research that discuss racial and ethnic disparities in maternal and perinatal outcomes. RECENT FINDINGS: Epidemiological research confirms the presence of maternal and neonatal disparities in national and multistate database analysis. These disparities are associated with geographical variations, hospital characteristics and practice patterns, and patient demographics and comorbidities. Proposed solutions include expanded perinatal insurance coverage, increased maternal healthcare public funding, and quality improvement initiatives/efforts that promote healthcare protocols and practice standardization. SUMMARY: Obstetrical healthcare disparities are persistent, prevalent, and complex and are associated with systemic racism and social determinants of health. Some of the excess disparity gap can be explained through community-, hospital-, provider-, and patient-level factors. Providers and healthcare organizations should be mindful of these disparities and strive to promote healthcare justice and patient equity. Several solutions provide promise in closing this gap, but much effort remains.

Opioid use disorder and maternal outcomes following cesarean delivery: a multistate analysis, 2007-2014.

Aim: To examine the association between opioid use disorder (OUD) and maternal outcomes following cesarean delivery. Methods: Retrospective analysis of over 2.4 million discharge records for in-patient cesarean delivery across five states from 2007 to 2014. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS) and 30- and 90-day readmission rates. Results: OUD patients were 148% more likely than non-OUD patients to die during hospitalization (adjusted odds ratios [aOR]: 2.48, 95% CI: 1.20, 5.10; p < 0.05). OUD was associated with increased odds of 30-day readmission (aOR: 1.46, 95% CI: 1.30, 1.65; p < 0.001) and 90-day readmission (aOR: 1.70, 95% CI: 1.55, 1.88; p < 0.001); LOS was not significantly different. Conclusion: OUD predicts increased in-patient mortality and odds of 30- and 90-day readmission following cesarean delivery.