Objective Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. Methods This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai‘i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. Results After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. Conclusion We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai’i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

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This pilot study examined whether California public health agencies collaborate with Mexican counterparts when developing and implementing social marketing campaigns that target Mexican immigrants in California. We also examined barriers to collaboration and factors contributing to successful partnerships. We recruited 13 and conducted 8 qualitative interviews (62% response rate) with social marketing staff from California public health agencies and contractors whose activities spanned four priority health areas for Mexican immigrants. Results include a desire to collaborate with Mexican counterparts but limited actual collaboration. Factors stated to affect the quality of binational social marketing collaborations included (1) the importance of communication and a working relationship between both parties, (2) funding issues, (3) evaluation activities, (4) administrative issues, especially travel restrictions, and (5) social stigmatization of the target audience. Policy recommendations include increasing funding available for binational collaborations, reducing administrative barriers, and building capacity on both sides of the U.S.—Mexico border. Such efforts may promote binational discussions that may benefit Mexican immigrants in new and established receiving communities in the United States while potentially promoting continuity of social marketing messages and campaigns. Our data suggest that binational social marketing campaigns may be feasible, though several barriers to their execution must be addressed.

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Objective This study aimed to compare cesarean delivery (CD) rates and maternal/neonatal outcomes before and after the 2014 ACOG/SMFM Obstetric Care Consensus for Safe Prevention of Primary CD. Study Design This retrospective study compared unscheduled CD rates and outcomes of singleton, cephalic, term pregnancies at a tertiary-care teaching maternity hospital. Births 5 years before (March 2009–February 2014) and after (June 2014–May 2019) release of the consensus were included. Chi-square and t-test were used to compare outcomes and logistic regression to adjust for confounders. Results In this study, 44,001 pregnancies were included, 20,887 before and 23,114 after the consensus. Unscheduled CD rates increased after the consensus (12.9 vs. 14.3%, p < 0.001); however, there was no difference after adjustment (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.91–1.03). Vaginal birth after cesarean (VBAC) deliveries increased among multiparas (4.8 vs. 7.2%, p < 0.001), which remained significant after adjustment (aOR, 1.51; 95% CI, 1.37–1.66). Postpartum hemorrhage, blood transfusion, and chorioamnionitis were modestly increased, while third-degree perineal lacerations decreased. Uterine rupture and neonatal outcomes were unchanged after adjustment. Conclusion At our tertiary-care maternity hospital, the Safe Prevention of Primary CD Care Consensus was not associated with a change in unscheduled CD, though VBAC deliveries increased. We did not demonstrate improved neonatal outcomes and showed increased maternal morbidity that warrants further study. Key Points