Near miss maternal mortality in a multiethnic population.

Purpose: To determine the impact of ethnicity on "near miss"/severe obstetric morbidity in a multi-ethnic, tertiary care population.

Methods: We carried out a cross-sectional analysis using birth data for 12,774 women with Medicaid who gave birth between January 1994 and January 2005 at Duke University. Univariate and multivariate analyses were carried out to compare ethnic groups and risk factors for severe obstetric morbidity and mortality using codes for conditions corresponding to the WHO definitions of near miss maternal morbidities.

Results: African-American women experienced significantly more pregnancy complications (25.4%) compared to White (21.7%) and Hispanic (18.8%) women. The presence of medical comorbidities was highest among African-Americans (9.1%) compared to Whites (8.1%) and Hispanics (2.6%). Near miss mortality, however, was significantly higher in Hispanic women (5.9%) compared to African-Americans (4.6%), and Whites (4.1%). Hispanic women had 45% greater risk of near miss mortality compared to Whites (relative risk [RR] = 1.45, 95% confidence interval [CI]: 1.14-1.84) whereas differences were non-significant for African-American women. In multivariate regression, near misses remained highest for Hispanic women (RR = 1.66; 95% CI: 1.27-2.17).

Conclusions: The increase in near miss maternal mortality for Hispanic women suggests a more complex interaction between ethnicity, socioeconomic status and health than traditional birth outcome measures capture.