摘要：Objectives. To assess maternal health disparities, we compared maternal morbidities during labor and delivery among Mexican-born and US-born White, non-Latina women residing in California. Methods. This population-based study used linked hospital discharge and birth certificate data for 1996–1998 (862723 deliveries). We calculated the frequency, and observed and adjusted odds ratios for obstetric complications. Covariates included maternal age, parity, education, prenatal care initiation and payment source, and hospital quality of care. Results. Approximately 1 in 5 deliveries resulted in a obstetric complication. After control for covariates, Mexican-born women were significantly less likely to have 1 or more maternal morbidities than White, non-Latina women but more likely to have complications that reflect the quality of intrapartum care. Conclusions. Maternal morbidities during labor and delivery are a substantial burden for women in California. The favorable overall outcome of Mexican-born women over US-born White, non-Latinas is surprising given their lower educational attainment, relative poverty, and greater barriers to health care access. The favorable outcomes obscure vulnerabilities in those complications that are sensitive to the quality of intrapartum care. Maternal morbidity is a key indicator of how well a health system responds to the needs of women, as pregnancy and birth complications are largely preventable. 1 Because most serious complications of pregnancy occur during childbirth, the primary national effort is aimed at reducing maternal complications during hospitalized labor and delivery from 31.2 to 24 per 100 deliveries. 2 , 3 In response to this challenge, the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC), with various partners, has been defining the collective conditions resulting from pregnancy that affect women’s health during childbirth. 4 , 5 Estimating the prevalence of these conditions and understanding variations between and within populations is an important step towards reducing social disparities in maternal health, identifying risk and protective factors, and developing targeted interventions. Globally, the major social contributors to maternal morbidity are poverty, lack of education, early and frequent child bearing, inadequate health care, and low status in society. 6 Consequently, we would expect Mexican-born women living in the United States, who have low socioeconomic status, delayed access to prenatal care, and high fertility, to stand at higher risk of maternal complications compared to US-born White, non-Latina women. 7 Evidence is scant and controversial. One study found that Latina women of diverse national origins were more likely than White, non-Latina women to die of pregnancy-related causes. 8 Women born in Mexico and delivering in the United States had a higher risk of pregnancy-related death than Mexican American women. 8 In contrast, California hospital discharge data from 1987 to 1992 revealed the odds of hospitalization for pregnancy complications at 10% lower for Latinas than for White, non-Latinas. 9 Whereas health disparities in birth outcomes between infants born to White, non-Latina and Mexican-born women have been amply studied, and generally show lower rates of low birthweight and preterm births in infants of Mexican-born women, disparities in maternal complications during pregnancy have not been evaluated. Hence, it is not known whether the health advantage of the Mexican-born population also extends to maternal morbidity. This article compares maternal morbidity during labor and delivery of Mexican-born women and US-born White, non-Latina women residing in California. California is the state with the largest number of deliveries in the country, and a good testing ground for examining the health status of Mexican-born immigrants. Since 2001, over 1 in 4 births in the state are to women born in Mexico. 10 The rapid growth and nationwide dispersion of the Mexican population resulting from immigration and high fertility requires that we develop a better understanding of the maternal morbidities affecting this population.
