Examining disparities in severe maternal morbidity among pregnant people with placenta accreta spectrum

It is unknown whether disparities in Placenta Accreta Spectrum (PAS) outcomes contribute to overall disparities in maternal health. We aim to evaluate whether race/ethnicity and social vulnerability are associated with severe maternal morbidity among pregnant people with PAS. We conducted a retrospective cohort study of singleton gravidae with antenatally suspected, pathologically confirmed PAS who underwent cesarean hysterectomy January 2011–June 2021 by a multidisciplinary team at a large US center. Contemporaneous data abstraction collected relevant patient information, inclusive of self-reported race and ethnicity. Resident zip code was linked to Social Deprivation Index (SDI) score, a validated composite measure of area-level deprivation. SDI scores were divided into quartiles for analysis. Primary outcome was composite maternal morbidity: intraoperative transfusion of 4 or more red blood cell units, ureteric injury, unintentional cystotomy, vesicovaginal fistula, acute kidney injury, venous thromboembolism, pulmonary edema, reoperation, readmission, or maternal death. Univariate analyses and logistic regression were performed. Among our cohort of 339 PAS subjects, 231 had validated zip codes permitting linkage to SDI score. 118 (34.8%) were non-Hispanic White, 61 (18.0%) non-Hispanic Black, 131 (38.6%) Hispanic. Composite maternal morbidity was identified in 109 (32.2%), and this did not differ significantly by racial/ethnic group or by SDI quartile (Tables 1, 2). Intraoperative transfusion of 4 or more red blood cell units occurred more in those living in more deprived areas (34.5% vs. 24.6% in highest vs. lowest SDI quartile, p=0.03), but did not differ by racial/ethnic group. In regression analysis, odds of transfusion did not differ by SDI quartile. Neither racial/ethnic identity nor social deprivation was associated with composite maternal morbidity among gravidae with PAS in our cohort. We hypothesize that a standardized approach by an experienced team minimizes potential disparities, and that disparities may remain for other populations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)