Funded Projects

(SDAS) Advanced Maternal Method of Delivery: A Longitudinal Study of Maternal and Child Health Outcomes

Grantee: Boston University, BUMC
Principal Investigator: Candace Belanoff
Project Number: R40MC21520
Project Date: 2/1/2011

Age group(s)

• Women/Maternal
• Prenatal
• Perinatal/Infancy (0-12 months)

Abstract

Background: This longitudinal, population-based study will investigate whether the gap in maternal and child post-birth re-hospitalization rates attributable to method of delivery (MOD) is further increased by childbearing at advanced maternal age (35+ years). Previous studies have examined adverse outcomes of births to older mothers and rising cesarean rates among older mothers, but not at the interaction between these two phenomena. We additionally seek to identify whether this relationship differs across sociodemographic groups (by race/ethnicity and economic status). Whether or not age and method of delivery operate differently across race/ethnicity and economic status is also an area which has not been studied, though merits examination as rates of cesarean delivery have been shown to be higher among older African Americans and Hispanic mothers and may contribute to health disparities. Data: The PELL Data System, a Massachusetts population-based longitudinal reproductive data system, linking live birth and fetal death records to delivery and birth hospital discharge records, subsequent and prior hospital services records, and state programmatic data sources, currently contains data from 1998 to 2007, with the linkage of 2008 data available in late 2010. We will include deliveries in PELL occurring between 2000 and 2007 which were delivered vaginally or by primary (first time) cesarean delivery, full term (37-41 weeks) normal birthweight (2500-4500g) and with no major pre-existing child malformations, (n=214,971). Analysis: We will use the longitudinally linked PELL hospital data to identify post-birth hospitalizations, the main outcome of interest, occurring among women and children within one year post-partum. Logistic regression modeling will be used to estimate the effect of maternal age, MOD and their interaction on likelihood of re-hospitalization, adjusting for multiple health and demographic factors. Stratified analyses across categories of race/ethnicity and economic status will be conducted to examine whether the age/MOD relationship is further modified by these sociodemographic factors. Coordination with MCHB Strategic Research Issues: Because a central focus of the study will be examining whether the differential distribution of cesarean delivery across racial and ethnic groups contributes to health disparities among women and children, this research project coordinates with MCHB's Strategic Research Issue II: "MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations." MCHB's Strategic Research Issue III, "Services and systems to assure quality of care for MCH populations" is also addressed in that we will be analyzing quality of care as indicated by outcomes associated with method of delivery and potentially improving the capability of clinicians to anticipate adverse maternal and child outcomes associated with maternity care services. This study also fits with the lifecourse approach to MCH research, in its focus on longitudinal analysis, consideration of health events at different maternal ages, and including preconception and interconception factors in analyses.