Poster Session 3
Category: Health Equity/Community Health
Poster Session 3
Bridget C. Huysman, MD, MPH (she/her/hers)
Physician
University of Chicago
Chicago, Illinois, United States
April Y. Lewis, MD (she/her/hers)
Resident Physician
Washington University School of Medicine
St. Louis, Missouri, United States
Mia Malcolm, BS, Pharm D
Washington University School of Medicine
St. Louis, Missouri, United States
Harry A. Obeng, MBBCH
School of Public Health, Washington University in St. Louis
Washington University in St. Louis, Missouri, United States
Paige Wilder, BS
Washington University School of Medicine
Saint Louis, Missouri, United States
Maya Bussey, BS
Medical Student
Washington University School of Medicine
St. Louis, Missouri, United States
Lori Atwood, BA
Washington University School of Medicine
Washington University School of Medicine, Missouri, United States
Adia Woodson, BS, RN
Washington University in St. Louis
Saint Louis, Missouri, United States
Monique Gill, MA
Associate Director/LPC, Perinatal Behavioral Health Service
Washington University School of Medicine
St. Louis, Missouri, United States
Rachel Witt, MD
Children's Minnesota
Minneapolis, Minnesota, United States
Eve Colson, MD, MEd
Washington University School of Medicine
St. Louis, Missouri, United States
Ebony Carter, MD, MPH (she/her/hers)
Maternal Fetal Medicine Physician, Division Director
University of North Carolina
Chapel Hill, North Carolina, United States
Candice L. Woolfolk, PhD, MPH
Assistant Professor
Washington University School of Medicine
Washington University School of Medicine, Missouri, United States
Racism and discrimination impact severe maternal morbidity (SMM) and obstetric (OB) complications. However, it is not known if a difference in discrimination correlates with morbidity risk. We sought to compare discrimination experienced by birthing persons who have an SMM by CDC criteria or unanticipated OB event (delivery morbidity) at delivery.
Study Design:
A prospective survey of a convenience sample of birthing people presenting for delivery at a single center from 03/2024 to 06/2025 using the Discrimination in Medical Settings Scale (DMSS) administered prior to discharge. Birthing people admitted for an indication not related to delivery, delivered off L&D or precipitously, or unable to speak English were excluded. DMSS scores were compared to people who experienced delivery morbidity and those who did not. We analyzed by reports of any discrimination, and ≥ 90th percentile (score 11). Survey responses were compared between groups using Chi-squared or Mann Whitney U tests as appropriate and multivariable logistic regression was used to estimate adjusted odds ratios(aOR) and 95% confidence intervals (CI).
Results:
Prior to discharge, 262 birthing people were approached to complete the survey, 83 declined, and 179 responded. Of those who participated, over 60% of the cohort identified as a person of color, of whom 15.1% experienced SMM, and 53.6% experienced an unanticipated OB complication. There was a statistically significant difference in reported total DMSS scores (8.24±3.31 SMM vs. 7.78±1.83, p=0.02). DMSS scores ≥ 90th percentile were significantly higher among those who experienced delivery morbidity compared to those who did not, with an almost 5 times higher risk of reporting discrimination (aOR 4.94 [95% CI 1.26, 19.37])(Table). Less courtesy and less respect were reported by those experiencing delivery morbidity (courtesy p< 0.01; respect p=0.04)(Table).
Conclusion:
Birthing people who experience discrimination may be at higher risk of morbidity at the time of delivery. Strategies to mitigate discrimination experienced during pregnancy care could be promising to reduce morbidity.