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Epidemiology

Poster Session 4

(1042) Racial disparities in maternal transfusion in the United States by mode of delivery

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To assess racial disparities in maternal transfusion in the United States (US) overall and stratified by mode of delivery.

Study Design:

We performed a population-based, retrospective cohort study of full term, live births in 2016-2021 using CDC US Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of maternal transfusion by self-identified maternal race in the total population, as well as among subgroups stratified by mode of delivery. Model adjustments are described in Figure 1.

Results:

The study included 16,339,947 patients; maternal transfusion occurred in 3.7 per 1000 deliveries. Compared with White patients (3.5 per 1000 transfusion rate), higher odds of transfusion were seen among American Indian and Alaska Native (AIAN), Black, Filipino, Korean, and Pacific Islander patients, while lower odds were found among Indian patients (Figure 1).

Rates of transfusion varied by mode of delivery: 2.3, 9.2, 5.3, 9.2, 5.1 per 1000 among spontaneous vaginal delivery (SVD), forceps, vacuum, cesarean deliveries (CD) with labor, and CD without labor, respectively. Among forceps deliveries, compared with White patients (9.1 per 1000 transfusion rate), Chinese patients had a nearly two-fold higher rate of transfusion (aOR 1.93, 95% CI 1.30-2.87), while Black patients had a nearly 30% lower rate of transfusion (aOR 0.71, 95% CI 0.56-0.91). Lower rates of transfusion in Black vs White patients were also observed in the SVD (2.2 vs 2.3 per 1000; aOR 0.93, 95% CI 0.90-0.97), vacuum (4.4 vs 5.3 per 1000; aOR 0.82, 95% CI 0.72-0.94), and CD with labor (9.0 vs 9.1 per 1000; aOR 0.91, 95% CI 0.87-0.95) groups, while a higher rate was shown among CDs without labor (7.0 vs 4.6 per 1000; aOR 1.39, 95% CI 1.34-1.44).

Conclusion:

Racial disparities in maternal transfusion in the US are evident and vary by mode of delivery. Disaggregation by mode of delivery showed the increase in transfusion among Black vs. White patients was confined among CDs without labor; Black patients had lower rates of transfusion in all other mode of delivery groups.