No longer rare diseases and obstetric anesthesia

Mangoubi, Eitan; Livne, Michal; Eidelman, Leonid A.; Orbach‐Zinger, Sharon

doi:10.1097/aco.0000000000000726

Cited by 2 publications

(2 citation statements)

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“…Specifically, the prevalence of hypertension, diabetes, thyroid disorders, autoimmune disorders, asthma, and mental health conditions have substantially increased . Furthermore, certain neurological and cardiac conditions that were once considered rare or incompatible with pregnancy are now seen with increasing frequency in pregnant patients …”

Section: Introductionmentioning

confidence: 99%

“…10,11 Furthermore, certain neurological and cardiac conditions that were once considered rare or incompatible with pregnancy are now seen with increasing frequency in pregnant patients. 12 It is well established that maternal comorbidity burden is associated with risk of SMM, 13 but there are relatively limited data on how the number and type of preexisting conditions affect mode of delivery among first-time pregnant patients. 14,15 The obstetric comorbidity index (OB-CMI) screening tool was originally developed and validated by Bateman et al 16 to predict SMM using utilization claims data.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Maternal Comorbidity Burden With Cesarean Birth Rate Among Nulliparous, Term, Singleton, Vertex Pregnancies

Wetcher,

Kirshenbaum,

Alvarez

et al. 2023

JAMA Netw Open

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IMPORTANCECesarean birth rate among nulliparous, term, singleton, vertex (NTSV) pregnancies is a standard quality measure in obstetrical care. There are limited data on how the number and type of preexisting conditions affect mode of delivery among primigravidae, and it is also uncertain how maternal comorbidity burden differs across racial and ethnic groups and whether this helps to explain disparities in the NTSV cesarean birth rate.OBJECTIVETo determine the association between obstetric comorbidity index (OB-CMI) score and cesarean delivery among NTSV pregnancies and to evaluate whether disparities in mode of delivery exist based on race and ethnicity group after adjusting for covariate factors.DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study of deliveries between January 2019 and December 2021 took place across 7 hospitals within a large academic health system in New York and included all NTSV pregnancies identified in the electronic medical record system. Exclusion criteria were fetal demise and contraindication to labor.EXPOSUREThe OB-CMI score. Covariate factors assessed included race and ethnicity group (American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, other or multiracial, and declined or unknown), public health insurance, and preferred language.MAIN OUTCOME AND MEASURESCesarean delivery.RESULTSA total of 30 253 patients (mean [SD] age, 29.8 [5.4] years; 100% female) were included. Non-Hispanic White patients constituted the largest race and ethnicity group (43.7%), followed by Hispanic patients (16.2%), Asian or Pacific Islander patients (14.6%), and non-Hispanic Black patients (12.2%). The overall NTSV cesarean birth rate was 28.5% (n = 8632); the rate increased from 22.1% among patients with an OB-CMI score of 0 to greater than 55.0% when OB-CMI scores were 7 or higher. On multivariable mixed-effects logistic regression modeling, there was a statistically significant association between OB-CMI score group and cesarean delivery; each successive OB-CMI score group had an increased risk. Patients with an OB-CMI score of 4 or higher had more than 3 times greater odds of a cesarean birth (adjusted odds ratio, 3.14; 95% CI, 2.90-3.40) than those with an OB-CMI score of 0. Compared with non-Hispanic White patients, nearly all other race and ethnicity groups were at increased risk for cesarean delivery, and non-Hispanic Black patients were at highest risk (adjusted odds ratio, 1.43; 95% CI, 1.31-1.55).CONCLUSIONS AND RELEVANCEIn this cross-sectional study of patients with NTSV pregnancies, OB-CMI score was positively associated with cesarean birth. Racial and ethnic disparities in this metric were observed. Although differences in the prevalence of preexisting conditions were seen across groups, this did not fully explain variation in cesarean delivery rates, suggesting that unmeasured clinical or nonclinical factors may have influenced the outcome.

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Section: Introductionmentioning

confidence: 99%