Impact of Race/Ethnicity and Insurance Status on Obstetric Outcomes: Secondary Analysis of the NuMoM2b Study

Maria S. Rayas, Jessian L. Munoz, Angela Boyd, Jennifer Kim, Cheyenne Mangold, Alvaro Moreira

Research output: Contribution to journalArticlepeer-review


Objective: This study aimed to investigate the impact of race/ethnicity and insurance status on obstetric outcomes in nulliparous women. Study Design: Secondary analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-To-Be. Obstetric outcomes included the development of a hypertensive event during pregnancy, need for a cesarean section, delivery of a preterm neonate, and postpartum hemorrhage. Results: Of 7,887 nulliparous women, 64.7% were non-Hispanic White (White), 13.4% non-Hispanic Black (Black), 17.8% Hispanic, and 4.1% were Asian. Black women had the highest rates of developing new-onset hypertension (32%) and delivering preterm (11%). Cesarean deliveries were the highest in Asian (32%) and Black women (32%). Individuals with government insurance were more likely to deliver preterm (11%) and/or experience hemorrhage after delivery. In multivariable analyses, race/ethnicity was associated with hypertension and cesarean delivery. More important, the adjusted odds ratios for preventable risk factors, such as obesity, diabetes, and severe anemia were greater than the adjusted odds ratios for race/ethnicity in terms of poor maternal outcome. Conclusion: Although disparities were observed between race/ethnicity and obstetric outcomes, other modifiable risk factors played a larger role in clinical differences.

Original languageEnglish (US)
Pages (from-to)E2907-E2918
JournalAmerican Journal of Perinatology
StatePublished - Jun 4 2024


  • health disparities
  • multivariable analysis
  • obstetrics
  • odd ratios
  • pregnancy
  • race/ethnicity

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health


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