Observed Versus Expected Distribution of Patient Self-Reported Race and Ethnicity in Quality Improvement Review Processes at a Single Safety Net Academic Institution.

Background While there is a plethora of evidence describing racial and ethnic disparities in obstetric care and outcomes, little has been published evaluating potential inequities in departmental Patient Safety and Quality Improvement (PSQI) processes.  Objective The study aims to describe the distribution of patient-reported race or ethnicity for safety events at a single safety net teaching hospital. We hypothesized that the observed versus expected case distribution for each racial or ethnic group would be similar, signifying proportional representation in the PSQI reporting and review process.  Study design We performed a cross-sectional study including all Safety Intelligence (SI) events filed on obstetric and gynecologic patients and all cases reviewed at monthly PSQI multidisciplinary departmental meetings from May 2016 to December 2021. We compared the distribution of patients' self-reported race or ethnicity as documented in the medical record to our patient population's expected race or ethnicity distribution based on historical institutional data. Results Two thousand and five SI events were filed on obstetric and gynecologic patients. Of those, 411 cases were selected for review by the departmental multidisciplinary PSQI committee, which meets once monthly. Of the 411 cases reviewed by the PSQI committee, 132 met Severe Maternal Morbidity (SMM) criteria defined by the American College of Obstetricians and Gynecologists (ACOG). Fewer SI reports were filed on Asian patients and those who declined to provide race or ethnicity (observed 4.3% versus expected 5.5%, p=0.0088 and 2.9% versus expected 1%, p<0.0001, respectively). For cases reviewed by the departmental PSQI committee and for those which met SMM criteria, there was no significant difference in race/ethnicity distribution. Conclusions There was a disparity between fewer safety events filed for Asian patients and those not reporting race/ethnicity. It was reassuring that our process did not identify other racial/ethnic disparities. However, given the widespread systemic inequities in healthcare, further evaluation of our PSQI process, and PSQI processes beyond our institution, is needed.

Adverse perinatal outcomes in pregnancies affected by severe COVID-19 infection.

BACKGROUND: Severe COVID-19 infection in pregnancy has been associated with an increase in adverse perinatal outcomes, although studies differ regarding which outcomes are affected. Increased characterization of obstetrical and neonatal outcomes is needed, including details on indications for preterm delivery and additional neonatal adverse outcomes. OBJECTIVE: This study aimed to determine whether there is a higher rate of adverse perinatal outcomes with severe-to-critical COVID-19 infection compared with nonsevere COVID-19 diagnosed during pregnancy. STUDY DESIGN: This was a retrospective observational cohort study that compared rates of adverse perinatal outcomes between patients with severe-to-critical and those with nonsevere (asymptomatic, mild, or moderate) COVID-19 infection. Patients had singleton pregnancies and a positive laboratory polymerase chain reaction result for COVID-19. Primary outcomes included hypertensive disorders of pregnancy, cesarean delivery, fetal growth restriction, preterm birth, and neonatal intensive care unit admission. Additional neonatal outcomes analyzed included need for cardiopulmonary resuscitation, low birthweight (<2500 g), 1- or 5-minute Apgar score <7, need for supplemental oxygen, need for intubation, intraventricular hemorrhage, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusion, necrotizing enterocolitis, hypoxic-ischemic encephalopathy, birth trauma, or neonatal death. Appropriate bivariate analyses were used to compare groups. Logistic regression was used to examine primary outcomes while adjusting for confounders. RESULTS: A total of 441 participants were identified and confirmed via detailed chart review to be pregnant with a singleton pregnancy while diagnosed with COVID-19. Of these, 44 (10%) met National Institutes of Health criteria for severe-to-critical COVID-19 infection. The median gestational age at the time of maternal COVID-19 diagnosis was 36.4 weeks (interquartile range, 29.6-38.6). Severe-to-critical COVID-19 infection had a higher risk of a composite adverse neonatal outcome (36.4% vs 21.4%; P=.03). There was a high incidence of hypertensive disorders of pregnancy overall (20.6%), but this outcome was not higher in the severe-to-critical vs nonsevere group. There were no maternal deaths. There was a low incidence of neonatal COVID-19 test positivity among those tested (1.8%). When adjusting for presence of heart disease and gestational age at COVID-19 diagnosis, severe-to-critical COVID-19 was strongly associated with fetal growth restriction (adjusted odds ratio, 2.73; confidence interval, 1.03-7.25) and neonatal intensive care unit admission (adjusted odds ratio, 3.50; confidence interval, 1.56-7.87). Preterm delivery was more common but was no longer significant after adjustment (adjusted odds ratio, 2.23; confidence interval, 0.99-5.05). CONCLUSION: Severe-to-critical COVID-19 infection during pregnancy is associated with higher rates of adverse neonatal outcomes and strongly associated with neonatal intensive care unit admission and fetal growth restriction compared with nonsevere disease. There is a high rate of hypertensive disorders of pregnancy overall in all those affected by COVID-19, regardless of severity. Pregnant persons should be counseled on these risks to encourage vaccination, and those with infection during pregnancy should be monitored for fetal growth disorders.