Racial & ethnic disparities in prenatal care & pregnancy outcomes - an ongoing challenge

Objective: The aim of this study is to compare adequacy of prenatal care among various races and ethnicities in the state of Michigan and associated pregnancy and birth outcomes. Study Design: A population-based retrospective cohort study was performed using the state of Michigan’s birth registry data for the years 2019-2020. Inclusion was made for all women who delivered after 20 weeks of gestation. Pregnancy and birth outcomes were compared by race and ethnicity. Results: A total of 211,801 births took place in Michigan between 2019 and 2020. The cohort included 143,400 (67.7%) who identified as non-hispanic White, 39,139 (18.5%) who identified as non-hispanic Black, 14,704 (6.9%) who identified as hispanic, and 14,557 (6.9%) who identified as others. Adequate prenatal care received, defined by the Kessner Index, was highest among non-hispanic White women at 71.9% (n=103,127), followed by hispanic women at 61.2% (n=9,006), followed by non-hispanic Black women at 56.1% (n=21,969), p\u3c 0.0001. The incidence of preterm birth was highest among non-hispanic Black women at 16.7% (n=6,525), followed by non-hispanic White women and hispanic women at 10.0% (n=14,358) and 10.8% (n=1,582) respectively, p\u3c 0.0001. The incidence of preeclampsia was also highest among non-hispanic Black women at 9.1% (n=3,550), followed by hispanic women and non-hispanic White women at 6.4% (n=948) and 1.3% (n=1,858) respectively, p\u3c 0.0001. The incidence of maternal ICU admission was 39% higher among non-hispanic Black women compared to non-hispanic White women (0.17% vs 0.12%). The incidence of neonatal ICU admission was 62% higher among non-hispanic Black women compared to non-hispanic White women (11.4% vs 7.0%). Conclusion: Disparities in prenatal care, pregnancy complications, and birth outcomes remain prevalent to our current day where non-hispanic Black women are receiving the least adequate prenatal care and having the most significant adverse pregnancy outcomes. More efforts should focus on access to care for Black women, as a modifiable step towards improving health outcomes for this population