Associations between ethnicity and admission to intensive care among women giving birth: a cohort study

the NMPA project team

doi:10.1111/1471-0528.16891

Associations between ethnicity and admission to intensive care among women giving birth: a cohort study

the NMPA project team

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design: Cohort study. Setting: Maternity and intensive care units in England and Wales. Population or sample: A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main outcome measures: Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. Results: In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82–2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37–2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions: Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Tweetable abstract: Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.

Original language	English
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
DOIs	https://doi.org/10.1111/1471-0528.16891
Publication status	Accepted/In press - 2021

Keywords

ethnicity
obstetric haemorrhage
severe maternal morbidity

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10.1111/1471-0528.16891

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@article{430a35cd90d849fe9f78c1aa43d0d100,

title = "Associations between ethnicity and admission to intensive care among women giving birth: a cohort study",

abstract = "Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design: Cohort study. Setting: Maternity and intensive care units in England and Wales. Population or sample: A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main outcome measures: Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. Results: In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82–2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37–2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions: Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Tweetable abstract: Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.",

keywords = "ethnicity, obstetric haemorrhage, severe maternal morbidity",

author = "{the NMPA project team} and J. Jardine and I. Gurol-Urganci and T. Harris and J. Hawdon and Dharmintra Pasupathy and {van der Meulen}, J. and K. Walker and Harriet Aughey and Andrea Blotkamp and Fran Carroll and Megan Coe and George Dunn and Alissa Fremeaux and Rebecca Geary and Hannah Knight and Lindsey Mamza and Natalie Moitt and Patrick Muller and Dharmintra Pasupathy and Sophie Relph and Louise Thomas and Lara Waite and Kirstin Webster",

note = "Funding Information: The National Maternity and Perinatal Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP; www.hqip.org.uk ) as part of the National Clinical Audit and Patient Outcomes Programme and funded by NHS England and the Scottish and Welsh governments. Neither HQIP nor the funders had any involvement in designing the study; collecting, analysing and interpreting the data; writing the report; or the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 John Wiley & Sons Ltd. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

doi = "10.1111/1471-0528.16891",

language = "English",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Associations between ethnicity and admission to intensive care among women giving birth

T2 - a cohort study

AU - the NMPA project team

AU - Jardine, J.

AU - Gurol-Urganci, I.

AU - Harris, T.

AU - Hawdon, J.

AU - Pasupathy, Dharmintra

AU - van der Meulen, J.

AU - Walker, K.

AU - Aughey, Harriet

AU - Blotkamp, Andrea

AU - Carroll, Fran

AU - Coe, Megan

AU - Dunn, George

AU - Fremeaux, Alissa

AU - Geary, Rebecca

AU - Knight, Hannah

AU - Mamza, Lindsey

AU - Moitt, Natalie

AU - Muller, Patrick

AU - Pasupathy, Dharmintra

AU - Relph, Sophie

AU - Thomas, Louise

AU - Waite, Lara

AU - Webster, Kirstin

N1 - Funding Information: The National Maternity and Perinatal Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP; www.hqip.org.uk ) as part of the National Clinical Audit and Patient Outcomes Programme and funded by NHS England and the Scottish and Welsh governments. Neither HQIP nor the funders had any involvement in designing the study; collecting, analysing and interpreting the data; writing the report; or the decision to submit the article for publication. Publisher Copyright: © 2021 John Wiley & Sons Ltd. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design: Cohort study. Setting: Maternity and intensive care units in England and Wales. Population or sample: A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main outcome measures: Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. Results: In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82–2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37–2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions: Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Tweetable abstract: Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.

AB - Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design: Cohort study. Setting: Maternity and intensive care units in England and Wales. Population or sample: A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main outcome measures: Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. Results: In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82–2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37–2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions: Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Tweetable abstract: Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.

KW - ethnicity

KW - obstetric haemorrhage

KW - severe maternal morbidity

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U2 - 10.1111/1471-0528.16891

DO - 10.1111/1471-0528.16891

M3 - Article

AN - SCOPUS:85115623430

SN - 1470-0328

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

ER -

Associations between ethnicity and admission to intensive care among women giving birth: a cohort study

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Keywords

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