563 - Chorioamnionitis, Cesarean deliveries, and racial disparities in the U.S.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 563
Publication Number: 563.412

Injy El-Dib, Brown Univeristy, Foxborough, MA, United States; Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Firas Saker, Cleveland Clinic Children's, Cleveland, OH, United States; JALAL M. ABU-SHAWEESH, Cleveland Clinic Children's, CLEVELAND, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Clinic Children's, Cleveland, OH, United States

Presenting Author(s)

Injy El-Dib

Undergraduate student researcher
Brown Univeristy

Background:

The presence of chorioamnionitis may affect the decision to have a CD, however, it is not known if such a decision is affected by the mothers’ race/ethnicity.

Objective:

To examine the association of the presence of chorioamnionitis on the rate of CD and explore the impact of maternal race/ethnicity on such association.

Design/Methods:

We examined the National Inpatient Sample produced by the Health Cost and Utilization Project in the years 2016-2018. We identified the mode of delivery and the presence of chorioamnionitis and other clinical variables. We examined the association of CD with chorioamnionitis in the overall sample and within each race using chi square testing. We then compared the association to deliver via CD if developed chorioamnionitis between Caucasians and African Americans to calculate adjusted odds ratios (aOR) using logistic regression models while controlling for factors associated with CD such as breech or mal-presentation, nuchal cord or cord prolapse, placental previa or abruption, maternal diabetes or macrosomia, maternal hypertension, or pre-eclampsia, and fetal sex, gestational age, birth weight and fetal distress.

Results:

There were 6,925,920 infants in the sample. Overall, 42.3% of mothers with chorioamnionitis delivered via CD compared to 33.3% in mothers with no chorioamnionitis, aOR 1.40 (1.38-1.43), p < 0.001. Among Caucasians, 0.78% of the infants were born to mothers with chorioamnionitis, 32.5% delivered via CD, and 41.2% of the infants born to mothers with chorioamnionitis were delivered via CD compared to 32.4% in mothers with no chorioamnionitis, aOR 1.46 (1.43-1.49), p < 0.001. Among African Americans, 1.1% of the infants were born to mothers with chorioamnionitis, 36.7% were delivered via CD, and 45.0% of the infants born to mothers with chorioamnionitis were delivered via CD compared to 36.6% in those with no chorioamnionitis, aOR 1.42 (1.37-1.47), p < 0.001. However, using logistic regression model to examine the association being delivered via CD among African Americans compared to Caucasians while controlling for chorioamnionitis, and other confounding factors mentioned above, revealed an aOR of 1.18 (1.17-1.18), p < 0.001.

Conclusion(s):

The presence of chorioamnionitis is associated with increased chance of delivering via CD. This association is higher in African Americans compared to Caucasians. Such findings warrant further investigation to explore factors associated with such racial discrepancy.