Diverse nursing staff reduces risk for adverse maternal outcomes
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Having a diverse registered nurse workforce was associated with a lower risk for severe adverse maternal outcomes during delivery, data in the American Journal of Obstetrics & Gynecology MFM showed.
Notably, a diversified workforce lowered the risk for adverse outcomes among white mothers.
“Addressing racial and ethnic disparities in maternal health is an urgent public health priority in the United States,” Jean R. Guglielminotti, MD, PhD, an assistant professor in the department of anesthesiology at Columbia University in New York City, told Healio. “Compared with white mothers, racial and ethnic minority mothers are up to three times more likely to experience life-threatening complications or to die during childbirth.”
Data extraction
Guglielminotti and colleagues reviewed 3,668,813 U.S. birth certificates from 2017 to assess the likelihood of severe adverse maternal outcomes, which included eclampsia, blood transfusion, hysterectomy and ICU admission. They excluded blood transfusion for adjusted analyses.
To determine each state’s proportion of registered nurses (RNs) who belonged to a racial or ethnic minority group, the researchers used data from the 2013 to 2017 American Community Survey. They divided states into terciles, ranging from the lowest proportion of RNs who were racial or ethnic minorities (3.3% in Maine) in the first tercile to the highest proportion of these RNs (68.2% in Hawaii) in the third tercile. The mean proportion of RNs in minority groups was 22.1%.
Incidence of adverse outcomes
Overall, 29,174 birth certificates reported severe adverse maternal outcomes (79.5 per 10,000; 95% CI, 78.6-80.4).
Severe adverse outcomes occurred in 85.3 per 10,000 white mothers who delivered in first tercile states and in 53.9 per 10,000 white mothers who delivered in third tercile states. This was associated with a 37% lower risk for severe adverse outcomes (crude OR = 0.63; 95% CI, 0.6-0.66).
The third tercile was also associated with decreased risk for adverse outcomes among mothers who were Black (crude OR = 0.65; 95% CI, 0.61-0.7), Hispanic (crude OR = 0.51; 95% CI, 0.48-0.54) and Asian and Pacific Islander (crude OR = 0.65; 95% CI, 0.58-0.72).
Upon adjustment, the risk for severe adverse outcomes in the third tercile was 32% lower for white mothers (adjusted OR = 0.68; 95% CI, 0.59-0.77), 20% lower for Black mothers (aOR = 0.8; 95% CI, 0.65-0.99), 31% lower for Hispanic mothers (aOR = 0.69; 95% CI, 0.58-0.82) and 50% for Asian and Pacific Islander mothers (aOR = 0.5; 95% CI, 0.38-0.65).
However, the risk for severe adverse maternal outcomes was not lower in the third tercile among Native American mothers (crude OR = 0.89; 95% CI, 0.72-1.09) or mothers of multiple races (crude OR = 1.44; 95% CI, 0.72-1.09). There were no statistically significant differences in risk for either group upon adjustment.
“Our findings could be used as supporting evidence for the development of intervention programs to reduce racial and ethnic disparities in maternal health outcomes by diversifying the health care workforce,” Guglielminotti said.
“We would like to see more research on the effect of a racially diverse workforce on other maternal outcomes (eg, pain management during labor or after childbirth) and on the effect of interventions to diversify the workforce (eg, pipeline programs) in reducing racial and ethnic disparities in maternal health,” he added.