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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Health Equity/Community Health

Poster Session 4

(1050) Association Between Severe Maternal Morbidity and Racism in Electronic Medical Records: A Case-Control Mixed-Methods Study

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
There are 4 forms of contemporary racism (interpersonal, internalized, institutional, and structural) in healthcare that contribute to racial inequities. Little is known about whether these forms of racism are notable in the electronic medical record (EMR). We aimed to identify evidence of racism in the EMR and determine if there was an association with severe maternal morbidity (SMM).

Study Design:
A case control study of pregnant patients with SMM was performed in our hospital system from 2018-23. SMM cases were matched 1:1 to controls by delivery date, gestational age(GA), age, race, ethnicity, insurance status, and mode of delivery. A data dictionary containing examples was created with guidance of 2 maternal fetal medicine subspecialists. Chart review and qualitative content analysis of pregnancy records for SMM and controls was performed by 3 independent reviewers. Presence of racism within each form was determined. Clinical and sociodemographic characteristics were compared across the two groups using chi-square or ANOVA as appropriate. Odds ratios were calculated using JMP.

Results:
198 cases of SMM and 198 controls were identified. Differences among the groups were noted in hypertensive disorders of pregnancy (HDP), pregestational diabetes (DM), compliance with treatment plan, and food/housing insecurity (Table 1). The odds of having evidence of racism in the EMR were higher (1.96; CI 1.3-3.0) in the SMM group compared to controls (Table 2). The relationship remained significant after adjusting for HDP, DM, gestational diabetes, chronic hypertension, age, race and GA. Among the forms of racism, odds of evidence of structural and institutional racism in the EMR were higher in the SMM group (Table 2).

Conclusion:
This is one of the first studies to demonstrate that evidence of racism in the EMR is significantly associated with SMM. Our findings also suggest a stronger association with structural racism and SMM compared to interpersonal interactions. Further studies are needed to explore qualitative themes within these forms of racism to inform effective interventions that could decrease SMM.