Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, the Department of Biostatics and Bioinformatics, and the Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
Obstet Gynecol. 2024 May 1;143(5):690-699. doi: 10.1097/AOG.0000000000005564. Epub 2024 Mar 28.
To evaluate the influence of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial and the coronavirus disease 2019 (COVID-19) pandemic on racial and ethnic differences in labor induction, pregnancy-associated hypertension, and cesarean delivery among non-Hispanic Black and non-Hispanic White low-risk, first-time pregnancies.
We conducted an interrupted time series analysis of U.S. birth certificate data from maternal non-Hispanic Black and non-Hispanic White race and ethnicity, first pregnancy, 39 or more weeks of gestation, with no documented contraindication to vaginal delivery or expectant management beyond 39 weeks. We compared the rate of labor induction (primary outcome), pregnancy-associated hypertension, and cesarean delivery during three time periods: pre-ARRIVE (January 1, 2015-July 31, 2018), post-ARRIVE (November 1, 2018-February 29, 2020), and post-COVID-19 (March 1, 2020-December 31, 2021).
In the post-ARRIVE period, the rate of labor induction increased in both non-Hispanic White and non-Hispanic Black patients, with no statistically significant difference in the magnitude of increase between the two groups (rate ratio for race [RR race ] 0.98, 95% CI, 0.95-1.02, P =.289). Post-COVID-19, the rate of labor induction increased in non-Hispanic White but not non-Hispanic Black patients. The magnitude of the rate change between non-Hispanic White and non-Hispanic Black patients was significant (RR race 0.95, 95% CI, 0.92-0.99, P =.009). Non-Hispanic Black pregnant people were more likely to have pregnancy-associated hypertension and more often delivered by cesarean at all time periods.
Changes in obstetric practice after both the ARRIVE trial and the COVID-19 pandemic were not associated with changes in Black-White racial differences in labor induction, cesarean delivery, and pregnancy-associated hypertension.
评估 ARRIVE（诱导与期待管理随机试验）试验和 2019 年冠状病毒病（COVID-19）大流行对非西班牙裔黑人和非西班牙裔白种人低危初产妇中分娩诱导、妊娠相关高血压和剖宫产术种族和民族差异的影响。
我们对美国母婴非西班牙裔黑人和非西班牙裔白种人种族和民族、初产妇、39 周或以上、无阴道分娩或期待管理至 39 周以上记录禁忌症的出生证明数据进行了一项中断时间序列分析。我们比较了三个时间段的分娩诱导率（主要结局）、妊娠相关高血压和剖宫产术：ARRIVE 之前（2015 年 1 月 1 日-2018 年 7 月 31 日）、ARRIVE 之后（2018 年 11 月 1 日-2020 年 2 月 29 日）和 COVID-19 之后（2020 年 3 月 1 日-2021 年 12 月 31 日）。
在 ARRIVE 之后的时期，非西班牙裔白人和非西班牙裔黑人患者的分娩诱导率均增加，但两组之间增加幅度无统计学差异（种族比值比[RR race ]0.98，95%置信区间，0.95-1.02，P =.289）。COVID-19 后，非西班牙裔白人患者的分娩诱导率增加，但非西班牙裔黑人患者则不然。非西班牙裔白人和非西班牙裔黑人患者之间的速率变化幅度差异有统计学意义（RR race 0.95，95%置信区间，0.92-0.99，P =.009）。在所有时间段，非西班牙裔黑人孕妇更有可能患有妊娠相关高血压，并且更常通过剖宫产分娩。
ARRIVE 试验和 COVID-19 大流行后产科实践的变化与分娩诱导、剖宫产术和妊娠相关高血压的黑人和白人种族差异的变化无关。
