Interaction of Maternal Race/Ethnicity, Insurance, and Education Level on Pregnancy Outcomes: A Retrospective Analysis of the United States Vital Statistics Records

The objective is to determine the association between maternal race/ethnicity, insurance, education level, and pregnancy outcomes. We queried the U.S. vital statistics records from 2015 to 2019 to analyze all deliveries. Using a multivariate analysis model, we determined the interaction between maternal race, insurance, education, and pregnancy outcomes. The outcome measures were the 5-min Apgar score, neonatal unit admission, neonates receiving assisted ventilation > 6 hours, mothers requiring blood transfusion, and the intensive care unit admission. There were 13,213,732 deliveries that met our inclusion criteria. In the study population, 52.7% were white, 14.1% blacks, 22.9% Hispanics, and 10.4% belonged to other races. 37.5% of the women had a high school education, 49.1% had a college education, and 12.3% had advanced degrees. Black mothers with high school education were more likely to require blood transfusion following delivery than Whites at the same education level, OR=1.08 (95% CI 1.05-1.11, p < 0.05). They were also more likely to be admitted into intensive care. The difference only disappeared among blacks with advanced education (OR=1.0; 95% CI 0.89-1.12, p > 0.05). Across all races/ethnicities, private insurance and advanced education were associated with better pregnancy outcomes. In the U.S., women with high socioeconomic status have better pregnancy outcomes across all races/ethnicities.