Racial disparities in birth outcomes persist among physicians

Racial disparities in birth outcomes persist among physicians | Image Credit: © BazziBa - © BazziBa - stock.adobe.com.

Racial and ethnic disparities remain in adverse maternal and birth outcomes among physicians, according to a recent study published in O&G Open.¹

Researchers continue to document significant racial and ethnic disparities in obstetric outcomes despite increased federal focused on improving reproductive health. In California, state-wide disparities have been observed, including greater decreases in preterm birth prevalence among White patients vs Black patients.²

“Several factors likely contribute to these disparities, including variation in the quality and quantity of health care, underlying health conditions, and social determinants of health, particularly those related to the historical and contemporary forms of structural and institutional racism,” wrote investigators.¹

Racial and ethnic comparison

The study was conducted to compare adverse pregnancy and birth outcomes between racial and ethnic groups among practicing physicians in California from 2012 to 2019. Data was collected from hospitalization records provided by the Department of Healthcare Access and Information and from vital statistics records.

Data about a patient’s usual occupation and usual type of business or industry was obtained from birth records. Patients with missing data about the date last worked before delivery or having a last day of work that did not overlap with pregnancy were excluded from the analysis.

Self-reported race and ethnicity was the primary exposure, obtained from neonatal birth records. These included Hispanic, non-Hispanic White, non-Hispanic Black, Asian, Native American, and Pacific Islander. Health records from prenatal or up to 6 weeks postpartum visits were assessed for relevant maternal outcomes.

Maternal and neonatal outcomes measured

Primary outcomes included preeclampsia, gestational diabetes, maternal morbidity, and severe maternal morbidity. These outcomes were based on International Classification of Diseases codes, and severe maternal morbidity included 21 CDC indicators.

Birth outcomes were also included, such as small for gestational age (SGA), birth weight, preterm birth, and neonatal intensive care unit (NICU) admission. Covariates included age at delivery, prepregnancy body mass index, source of payment for delivery, and prenatal smoking.

There were 14,878 singleton children born to physicians included in the analysis, 42.5% of whom were Asian, 40.8% non-Hispanic White, 8.9% Hispanic, 5.3% other races, and 3.2% non-Hispanic Black. Mothers were aged a mean 35 years at delivery and most had private insurance. Prenatal tobacco use was reported in under 1%.

Disparities in outcomes reported

Asian physicians had the highest rate of gestational diabetes at 14.2%, vs 10.2% for physicians of other races, 8.9% Hispanic physicians, and 6.4% for non-Hispanic Black physicians. Adjusted risk differences (aRDs) when compared with non-Hispanic White physicians were 8%, 3%, 2%, and -5%, respectively.

Non-Hispanic Black physicians had the highest rates of severe maternal morbidity alongside other races, at 2.8%. Other rates of severe maternal morbidity included 2.4% for Asian physicians, 2% for non-Hispanic White physicians, and 1.1% for Hispanic physicians.

SGA was also the most prevalent in Asian physicians, with a rate of 14.3%. This was followed by non-Hispanic Black, other races, Hispanic, and non-Hispanic White physicians, with rates of 12.9%, 10.9%, 9.1%, and 8.9%, respectively. Compared to non-Hispanic White physicians, aRDs were 5% for Asian and non-Hispanic Black physicians.

Preterm birth rates were 13.9%, 8.6%, and 8.5% among non-Hispanic Black, Asian, and physicians of all other race and ethnicity categories, respectively. NICU admission was reported in 8.8% of neonates from non-Hispanic Black physicians, 7% other races, 6.9% non-Hispanic White, 5.9% Asian, and 4.7% Hispanic.

Implications

These results highlighted racial and ethnic disparities for pregnancy complications among physicians in California. Investigators concluded this highlights the impact of sociostructural factors on pregnancy and birth outcomes.

“Further, the results highlight that in addition to the well-documented disparities in adverse birth outcomes of Black individuals, disparities also are present and deserve attention for birthing individuals who are Asian and for those of more than one race or of unknown race,” wrote investigators.

References

1. Caesar MA, Baer R, Bandoli G. Persistence of racial and ethnic disparities in adverse maternal and birth outcomes among physicians. O&G Open. 2025;2(3). doi:10.1097/og9.0000000000000086
2. Nicole Teal E, Baer RJ, Jelliffe-Pawlowski L, Mengesha B. Racial disparities in cesarean delivery rates: do hospital-level factors matter? Am J Perinatol. 2024;41:375–82. doi:10.1055/s-0043-1776346