Comparison of Primary Cesarean Delivery Rates Among Low-Risk Women in Urban and Rural Hospitals in Hawaii.

Objective The purpose of this study was to examine primary cesarean delivery rates among women with low risk pregnancies in urban and rural hospitals in Hawaii. Methods This is a retrospective study of all low-risk women (term, vertex, singleton) who had a primary cesarean delivery in any Hawaii hospital from 2010 to 2011 using a statewide health information database. Hospitals were divided into two categories: rural and urban. Results Of the 27,096 women who met criteria for this study, 7105 (26.2 %) delivered in a rural hospital. Low-risk women who delivered in a rural hospital had a primary cesarean delivery rate of 18.5 % compared to 11.8 % in the urban hospitals, p < .0001. Low-risk women who delivered at rural hospitals had significantly higher unadjusted and adjusted odds ratios for cesarean delivery. The association with rural hospital was stronger after adjusting for confounders, aOR 2.47 (95 % CI 2.23-2.73) compared to unadjusted OR 1.70 (95 % CI 1.58-1.83) for primary cesarean delivery. Conclusions on practice In a geographically isolated population, rates of primary cesarean delivery among low-risk women are significantly higher in rural hospitals. This disparity should be investigated further.

Maternal risk factors and perinatal outcomes among pacific islander groups in Hawaii: a retrospective cohort study using statewide hospital data.

BACKGROUND: Studies suggest Pacific Islander women have disparate rates of preterm birth, primary cesarean delivery, preeclampsia, gestational diabetes, and low birthweight infants. However, data is limited. In order to improve the health of Pacific Islanders, it is essential to better understand differences in obstetric outcomes in this diverse population METHODS: This study compared perinatal outcomes between Pacific Islander (9,646) and White (n = 5,510) women who delivered a singleton liveborn in any Hawaii hospital from January 2010 to December 2011 using the Hawaii Health Information Corporation (HHIC) database. Pacific Islanders were disaggregated into the following groups: Native Hawaiian, Samoan, Micronesian, and Other Pacific Islanders. Perinatal outcomes (e.g. hypertensive diseases, birthweight, mode of delivery) were compared using multivariable logistic models controlling for relevant sociodemographic and health risk factors (e.g. age and payer type). RESULTS: Significant differences in perinatal outcomes between Pacific Islander and White women and newborns were noted. All Pacific Islander groups had an increased risk of hypertension. Outcome differences were also seen between Pacific Islanders groups. Native Hawaiians had the highest risk of low birthweight infants, Samoans had the highest risk of macrosomic infants and Micronesians had the highest risk of cesarean delivery. CONCLUSIONS: Important differences in perinatal outcomes among Pacific Islanders exist. It is important to examine Pacific Islander populations separately in future research, public health interventions, and policy.

The prevalence of gestational diabetes among Micronesians in Honolulu.

OBJECTIVES: There is a high prevalence of type 2 diabetes among Micronesians leading to the assumption that they are at an increased risk for gestational diabetes. The objective of this study was to determine the prevalence of gestational diabetes among the Micronesian population in Honolulu, Hawai'i. Secondary objectives were to determine factors associated with gestational diabetes and compare maternal and fetal outcomes between the Micronesian gestational diabetic and non-diabetic populations. METHODS: A retrospective chart review was performed of all delivery records from January 1997 to December 2006. Data were analyzed using measures of association and multiple logistic regression. RESULTS: Of the 2966 charts reviewed, 2303 met inclusion criteria. The prevalence of gestational diabetes was 6.2% and the prevalence of type 2 diabetes was 0.8%. In comparison to the non-diabetic group, the gestational diabetic population was significantly older (p=0.002) and heavier (p<0.001). Micronesians with gestational diabetes had higher rates of cesarean section and hypertensive disorders. However, rates of shoulder dystocia were not statistically different. Infants of gestational diabetic mothers experienced higher rates of neonatal intensive care unit admission and hypoglycemia. CONCLUSION: The prevalence of gestational diabetes in the Micronesian population is lower than expected given the high prevalence of obesity and type 2 diabetes among Micronesians. Those with gestational diabetes are at an increased risk for maternal and neonatal morbidity. Future public health endeavors should address increasing rates of obesity in the United States, specifically in Pacific Islander populations.