Adverse Pregnancy and Neonatal Outcomes Among Marshallese Women Living in the United States

Abstract

Objective: Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods: We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results: Of the 91,662 singleton births in both counties during the study period, 2,488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of "other medical risk factors" (PR=1.47; 95% CI: 1.30, 1.65) than NH white women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH white women (

Implicit Racial Attitudes and Associations Among Obstetricians in Hawaiʻi: a Pilot Study

“…Similar to other racial minority groups, NHPIs and Micronesian communities specifically experience substantial disparities in health and healthcare outcomes [14][15][16][17]. Maternal and perinatal outcomes are no exception [18][19][20][21][22]. For example, rates of cesarean delivery among Micronesian women are significantly higher compared to White women, even after adjusting for medical and sociodemographic confounders [19,20].…”

“…Maternal and perinatal outcomes are no exception [18][19][20][21][22]. For example, rates of cesarean delivery among Micronesian women are significantly higher compared to White women, even after adjusting for medical and sociodemographic confounders [19,20]. In addition, a study that compared indications for cesarean between Micronesian and White patients found that Micronesian women were over three times more likely to experience a cesarean delivery for more subjective medical indications (e.g., non-reassuring fetal heart tracing and arrest of labor) compared to more objective indications, a finding consistent with similar work examining cesarean delivery among Black women in the US [22,23].…”

Pregnancy health and perinatal outcomes among Pacific Islander women in the United States and US Affiliated Pacific Islands: Protocol for a scoping review

“…Notably, several studies of pregnancy hypertension and diabetes had to be excluded for not distinguishing between pre-existing and pregnancy-induced dysfunction. [ 20 , 88 ] While the main goal of this paper was not to compare Pacific Islanders’ risk for poor pregnancy/perinatal outcomes to those of other groups, but rather to identify gaps in the research, it should be noted that the majority of studies found that Pacific Islanders had higher prevalence, risk, or odds of having adverse outcomes compared to their white counterparts [ 27 – 32 , 34 – 39 , 41 – 49 , 51 , 52 , 58 – 65 , 67 – 73 ]. The underlying cause of these disparities needs further research but may be due to lack of healthcare access, discrimination, or other social determinants as have been reported among other U.S. minority/immigrant populations [ 89 , 90 ].…”

Multicomponent Informed Consent with Marshallese Participants

“…Marshallese in the United States experience significant health disparities and report a high prevalence of diabetes, heart disease, and obesity (Hawley & McGarvey, 2015;Look et al, 2013;Mau et al, 2009;McElfish et al, 2017aMcElfish et al, , 2017bOkihiro & Harrigan, 2005;Schiller et al, 2012;Tung, 2012;US Department of Health & Human Services Office of Minority Health, 2015). Furthermore, Marshallese mothers are disproportionately likely to have poor maternal health outcomes compared to other racial and/or ethnic groups (Centers for Disease Control & Prevention, 2011;Chang et al, 2010Chang et al, , 2015Lavery et al, 2017;Nembhard et al, 2019aNembhard et al, , 2019bRao et al, 2006;Silva et al, 2006;Tsitas et al, 2015;Wartko et al, 2017). Pacific Islanders, and Marshallese specifically, are also underrepresented in research, which perpetuates and further obscures these health disparities impacting this vulnerable community (Compact of Free Association Community Advocacy Network, 2014;McGrath & Ka'ili, 2010;Palafox et al, 2002;Roehr, 2010).…”