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