Review
Obstetrics
Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants

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Wide disparities in obstetric outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality, and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities because of sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetric disparities, with an eye toward potential etiologies, thereby improving our ability to target appropriate solutions.

Section snippets

Congenital abnormalities

the most consistent racial/ethnic difference in prevalence of congenital abnormalities appears to be a higher incidence of neural tube defects (NTDs), including spina bifida and anencephaly, among Hispanic women.10, 11, 12, 13 Williams et al14 calculated a recent birth prevalence of spina bifida of 4.18 per 10,000 births among Hispanic women, as compared with 3.37 and 2.90 per 10,000 for non-Hispanic white and black women, respectively, similar to the findings of other studies.

In contrast, the

Disparities in obstetric care

Few agreed-on measures of quality of obstetric care currently exist for evaluation of disparities in care quality.131 The Agency for Healthcare Research and Quality's National Healthcare Disparities Report uses a set of measures to describe quality of care across a variety of settings. Whereas other areas in medicine have numerous available measures, the single measure that reflects quality of obstetric care in this report is the proportion of women who receive prenatal care in the first

Conclusions

As in other fields of medicine, obstetric outcomes differ by maternal race/ethnicity. These disparities ultimately contribute to disparate rates of infant and maternal mortality and thereby reflect the overall health status of the communities in which women and their families live. Whereas some disparities may have their origins in biology and therefore may not be modifiable in the short term, a great many more may be rooted in maternal health behaviors and the physical and social environments,

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    This study was supported in part by National Institutes of Health/National Center for Research Resources/Office of the Director, University of California, San Francisco-Clinical and Translational Sciences Institute Grant KL2 RR024130 (to A.S.B.). A.S.B. is also supported by the Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation.

    The views expressed herein are those of the authors and do not necessarily represent the official views of the National Institutes of Health.

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