Racial, Ethnic, and Economic Disparities in the Prevalence of Pregnancy Complications

  • Nedra S. Whitehead
  • William Callaghan
  • Chris Johnson
  • Letitia Williams


Objectives Our objective was to use maternal self-reported data to estimate the prevalence of urinary tract infections, placenta disorders, and preterm rupture of the membranes (PROM) and to explore the association between these complications and race, ethnicity, and economic status. Methods We used data for the years 2000–2002 from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing survey of women with a recent live birth, to examine the prevalence of and hospitalizations for self-reported urinary tract infections, placenta disorders, and PROM and to investigate differences by maternal race, Hispanic ethnicity, and economic status. Prevalence and hospitalizations were calculated as a percent of the represented population using SUDAAN to account for the sampling design. Results Urinary tract infections were commonly reported, occurring in more than 17% of women during their pregnancy. Placenta disorders and PROM were each reported by approximately 6% of women. Poverty and race had independent effects on each of the pregnancy complications examined. Fewer than half of the women who experienced these pregnancy complications were hospitalized. Conclusions Pregnancy complications are common and not adequately measured by hospitalizations alone. Both more research and improved surveillance are needed to understand the effect of pregnancy complications on women’s health and the reasons for the increased risk among poor or black women.


Pregnancy complications Urinary tract infections Fetal membranes Premature rupture Placenta disorders 



We acknowledge the contribution to PRAMS and this work by the PRAMS Working Group: Alabama: Albert Woolbright, PhD; Alaska: Kathy Perham-Hester, MS, MPH; Arkansas: Gina Redford, MAP; Colorado: Alyson Shupe, PhD; Florida: Helen Marshall; Georgia: Carol Hoban, MS, MPH; Hawaii: Limin Song, MPH, CHES; Illinois: Theresa Sandidge, MA; Louisiana: Joan Wightkin; Maine: Martha Henson; Maryland: Diana Cheng, MD; Michigan: Yasmina Bouraoui, MPH; Minnesota: Jan Jernell; Mississippi: Linda Pendleton, LMSW; Montana: JoAnn Dotson; Nebraska: Jennifer Severe-Oforah; New Jersey: Lakota Kruse, MD; New Mexico: Ssu Weng, MD, MPH; New York State: Anne Radigan-Garcia; New York City: Candace Mulready, MPH; North Carolina: Paul Buescher, PhD; North Dakota: Sandra Anseth, RN; Ohio: Amy Davis; Oklahoma: Dick Lorenz; Oregon: Ken Rosenberg, MD, MPH; Rhode Island: Sam Viner-Brown; South Carolina: Sylvia Sievers, PhD; Texas: Tanya J. Guthrie, PhD; Utah: Lois Bloebaum; Vermont: Peggy Brozicevic; Washington: Linda Lohdefinck; West Virginia: Melissa Baker, MA; CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.


  1. 1.
    Berg, C., Bruce, F. C., & Callaghan, W. M. (2002). From mortality to morbidity: The challenge of the twenty-first century. Journal of the American Medical Women’s Association, 57(173), 174.Google Scholar
  2. 2.
    Bacak, S. J., Callaghan, W. M., Dietz, P. M., & Crouse, C. (2005). Pregnancy-associated hospitalizations in the United States, 1999–2000. American Journal of Obstetrics and Gynecology, 192(2), 592–597.PubMedCrossRefGoogle Scholar
  3. 3.
    Bennett, T. A., Kotelchuck, M., Cox, C. E., Tucker, M. J., & Nadeau, D. A. (1998). Pregnancy-associated hospitalizations in the United States in 1991 and 1992: A comprehensive view of maternal morbidity. American Journal of Obstetrics and Gynecology, 178(2), 346–354.PubMedCrossRefGoogle Scholar
  4. 4.
    Franks, A. L., Kendrick, J. S., Olson, D. R., Atrash, H. K., Saftlas, A. F., & Moien, M. (1992). Hospitalization for pregnancy complications, United States, 1986 and 1987. American Journal of Obstetrics and Gynecology, 166(5), 1339–1344.PubMedGoogle Scholar
  5. 5.
    Scott, C. L., Chavez, G. F., Atrash, H. K., Taylor, D. J., Shah, R. S., & Rowley, D. (1997). Hospitalizations for severe complications of pregnancy, 1987–1992. Obstetrics and Gynecology, 90(2), 225–229.PubMedCrossRefGoogle Scholar
  6. 6.
    Danel, I., Berg, C., Johnson, C. H., & Atrash, H. (2003). Magnitude of maternal morbidity during labor and delivery: United States, 1993–1997. American Journal of Public Health, 93(4), 631–634.PubMedCrossRefGoogle Scholar
  7. 7.
    Gazmararian, J. A., Petersen, R., Jamieson, D. J., Schild, L., Adams, M. M., Deshpande, A. D., et al. (2002). Hospitalizations during pregnancy among managed care enrollees. Obstetrics and Gynecology, 100(1), 94–100.PubMedCrossRefGoogle Scholar
  8. 8.
    Chang, J., Elam-Evans, L. D., Berg, C. J., Herndon, J., Flowers, L., Seed, K. A., et al. (2003). Pregnancy-related mortality surveillance—United States, 1991–1999. Morbidity and Mortality Weekly Report, 52(SS02), 1–8.Google Scholar
  9. 9.
    Weissman, J. S., Gatsonis, C., & Epstein, A. M. (1992). Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. The Journal of the American Medical Association, 268(17), 2388–2394.CrossRefGoogle Scholar
  10. 10.
    Frederiksen, M. C., Glassenberg, R., & Stika, C. S. (1999). Placenta previa: A 22-year analysis. American Journal of Obstetrics and Gynecology, 180(6 Pt 1), 1432–1437.PubMedCrossRefGoogle Scholar
  11. 11.
    Ananth, C. V., Demissie, K., Smulian, J. C., & Vintzileos, A. M. (2001). Relationship among placenta previa, fetal growth restriction, and preterm delivery: A population-based study. Obstetrics and Gynecology, 98(2), 299–306.PubMedCrossRefGoogle Scholar
  12. 12.
    ACOG committee opinion. (2002) Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. International Journal of Gynaecology and Obstetrics, 77(1), 77–78.Google Scholar
  13. 13.
    Adams, M. M., Harlass, F. E., Sarno, A. P., Read, J. A., & Rawlings, J. S. (1994). Antenatal hospitalization among enlisted servicewomen, 1987–1990. Obstetrics and Gynecology, 84(1), 35–39.PubMedGoogle Scholar
  14. 14.
    Shulman, H. B., Gilbert, B. C., Msphbrenda, C. G., & Lansky, A. (2006). The pregnancy risk assessment monitoring system (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.PubMedGoogle Scholar
  15. 15.
    Whitehead, N. S., Callaghan, W., Johnson, C. H., & Williams, L. (2004). Maternal morbidity surveillance: Comparing hospital discharge data, birth certificates and confidential questionnaires. Presented at Society for Pediatric and Perinatal Epidemiology Annual Meeting, Salt Lake City, Utah, 14, June 2004.Google Scholar
  16. 16.
    Shah, B. V., Barnwell, B. G., & Bieler, G. S. (1996). SUDAAN user’s manual, release 7.0. Research Triangle Park: Research Triangle Institute.Google Scholar
  17. 17.
    Nicolle, L. E. (2003). Asymptomatic bacteriuria: When to screen and when to treat. Infectious Disease Clinics of North America, 17(2), 367–394.PubMedCrossRefGoogle Scholar
  18. 18.
    McDermott, S., Szwejbka, L., Mann, H., Durkin, M., & Callaghan, W. (2001). Urinary tract infections during pregnancy in South Carolina. Journal of the South Carolina Medical Association, 97(5), 195–200.Google Scholar
  19. 19.
    Schieve, L. A., Handler, A., Hershow, R., Persky, V., & Davis, F. (1994). Urinary tract infection during pregnancy: Its association with maternal morbidity and perinatal outcome. American Journal of Public Health, 84(3), 405–410.PubMedCrossRefGoogle Scholar
  20. 20.
    Stenqvist, K., Dahlen-Nilsson, I., Lidin-Janson, G., Lincoln, K., Oden, A., Rignell, S., et al. (1989). Bacteriuria in pregnancy. Frequency and risk of acquisition. American Journal of Epidemiology, 129(2), 372–379.PubMedGoogle Scholar
  21. 21.
    Kutlay, S., Kutlay, B., Karaahmetoglu, O., Ak, C., & Erkaya, S. (2003). Prevalence, detection and treatment of asymptomatic bacteriuria in a Turkish obstetric population. The Journal of Reproductive Medicine, 48(8), 627–630.PubMedGoogle Scholar
  22. 22.
    Teppa, R. J., & Roberts, J. M. (2005). The uriscreen test to detect significant asymptomatic bacteriuria during pregnancy. Journal of the Society for Gynecologic Investigation, 12(1), 50–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Akerele, J., Abhulimen, P., & Okonofua, F. (2001). Prevalence of asymptomatic bacteriuria among pregnant women in Benin City, Nigeria. Journal of Obstetrics Gynaecology, 21(2), 141–144.CrossRefGoogle Scholar
  24. 24.
    Ananth, C. V., Oyelese, Y., Yeo, L., Pradhan, A., & Vintzileos, A. M. (2005). Placental abruption in the United States, 1979 through 2001: Temporal trends and potential determinants. American Journal of Obstetrics and Gynecology, 192(1), 191–198.PubMedCrossRefGoogle Scholar
  25. 25.
    Lydon-Rochelle, M., Holt, V. L., Easterling, T. R., & Martin, D. P. (2001). First-birth cesarean and placental abruption or previa at second birth(1). Obstetrics and Gynecology, 97(5 Pt 1), 765–769.PubMedCrossRefGoogle Scholar
  26. 26.
    Bhide, A., & Thilaganathan, B. (2004). Recent advances in the management of placenta previa. Current Opinions in Obstetrics and Gynecology, 16(6), 447–451.CrossRefGoogle Scholar
  27. 27.
    Chama, C. M., Wanonyi, I. K., & Usman, J. D. (2004). From low-lying implantation to placenta praevia: A longitudinal ultrasonic assessment. Journal of Obstetrics and Gynaecology, 24(5), 516–518.PubMedCrossRefGoogle Scholar
  28. 28.
    Guinn, D. A., Goldenberg, R. L., Hauth, J. C., Andrews, W. W., Thom, E., & Romero, R. (1995). Risk factors for the development of preterm premature rupture of the membranes after arrest of preterm labor. American Journal of Obstetrics and Gynecology, 173(4), 1310–1315.PubMedCrossRefGoogle Scholar
  29. 29.
    Gardner, M. O., Goldenberg, R. L., Cliver, S. P., Tucker, J. M., Nelson, K. G., & Copper, R. L. (1995). The origin and outcome of preterm twin pregnancies. Obstetrics and Gynecology, 85(4), 553–557.PubMedCrossRefGoogle Scholar
  30. 30.
    Ladfors, L., Mattsson, L. A., Eriksson, M., & Milsom, I. (2000). Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near-term in an urban Swedish population. Journal of Perinatal Medicine, 28(6), 491–496.PubMedCrossRefGoogle Scholar
  31. 31.
    Pregnancy-related deaths among Hispanic Asian/Pacific Islander, and American Indian/Alaska Native women-United States, 1991–1997. MMWR Morb Mortal Weekly Report. (2001). May 11, 50(18), 361–4.Google Scholar
  32. 32.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., et al. (2007). Births: Final data for 2005. National Vital Statistics Reports, 56(6), 1–103.PubMedGoogle Scholar
  33. 33.
    Tomeo, C. A., Rich-Edwards, J. W., Michels, K. B., Berkey, C. S., Hunter, D. J., Frazier, L., et al. (1999). Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology, 10, 771–777.CrossRefGoogle Scholar
  34. 34.
    Buka, S. L., Goldstein, J. M., Seidman, L. J., & Tsuang, M. T. (2000). Maternal recall of pregnancy history: Accuracy and bias in schizophrenia research. Schizophrenia Bulletin, 26(2), 335–350.PubMedGoogle Scholar
  35. 35.
    Casey, R., Rieckhoff, M., Beebe, S. A., & Pinto-Martin, J. (1992). Obstetric and perinatal events: The accuracy of maternal report. Clinical Pediatrics, 31(4), 200–204.PubMedCrossRefGoogle Scholar
  36. 36.
    Olson, J. E., Shu, X. O., Ross, J. A., Pendergrass, T., & Robison, L. L. (1997). Medical record validation of maternally reported birth characteristics and pregnancy-related events: A report from the children’s cancer group. American Journal of Epidemiology, 145(1), 58–67.PubMedGoogle Scholar
  37. 37.
    Oates, R. K., & Forrest, D. (1984). Reliability of mothers’ reports of birth data. Australian Paediatric Journal, 20(3), 185–186.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nedra S. Whitehead
    • 1
  • William Callaghan
    • 2
  • Chris Johnson
    • 2
  • Letitia Williams
    • 2
  1. 1.RTI InternationalAtlantaUSA
  2. 2.Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA

Personalised recommendations