OBJECTIVES: A lack of access to or trust in the healthcare system are suspected to contribute to poor infant and maternal outcomes among Black women in the US. This retrospective study examined preterm births and adverse maternal outcomes among Black women stratified by historical healthcare use in a linked claims/EMR network.

METHODS: We used the TriNetX Platform and Linked Network to analyze birth outcomes among Black women aged 15-45 with ≥1 delivery (index date: first delivery) between 12/02/2011 and 12/31/2019. Women were included if their visit history fit one of three patterns: no prenatal (no visit 2-40 weeks pre-index), short history (≥1 visit 2-40 weeks pre-index but no visit prior to 40 weeks), long history (≥1 visit in each of the following periods: 2-40 weeks pre-index, 281 days-18 months pre-index, and ≥18 months pre-index). Continuous insurance enrollment was not required. Preterm delivery (O60.1) and poor maternal outcomes (hemorrhage, severe perineal laceration, placental abruption, uterine rupture and uterine inversion) within 7 days of delivery were compared using chi-square tests.

RESULTS: Among 63,277 Black women with a recorded delivery, 34,923 had a long history, 7,460 had a short history, and 2,293 had no prenatal record. Preterm births were more common in the no prenatal cohort (14.0%) compared with the short history cohort (7.3%, p<.001) or the long history cohort (6.8%, p<.001). However, while poor maternal outcomes were more common in the no prenatal cohort (6.1%) compared with the long history cohort (4.5%, p<.001), they were not significantly different when compared to the short history cohort (5.7%, p=0.432).

CONCLUSIONS: This analysis suggests that both prenatal and historical care contribute to birth outcomes among Black women. These findings suggest that interventions tailored to improving overall access and use of healthcare among Black women may be effective in addressing racial disparities in maternal health.