Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2026
Clinical Needs and Referral Patterns Among Black, Latin American, and Other Medically Uninsured Pregnant Patients: A 10-Year Toronto Medical Record Review.
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Handa Manavi
Аннотация
OBJECTIVES: To describe and compare demographic, access, clinical, and referral characteristics across self-identified Black, Latin American, and all other groups among medically uninsured pregnant patients attending a low-barrier Toronto clinic.
METHODS: We conducted a retrospective descriptive chart review of pregnancy presentations assessed from July 1, 2013 to June 30, 2023. Race/ethnicity was self-reported at intake. Categorical variables were summarized as n/N (%) using variable-specific denominators and 95% CIs. Continuous variables were summarized as mean (SD). Three-group comparisons were descriptive rather than causal.
RESULTS: The cohort included 1170 pregnancy presentations: 245 Black patients, 471 Latin American patients, and 454 "all other" patients. Presentation at 14 weeks or later occurred in 63.8%, 34.1%, and 46.4%, respectively. Interpreter requirement was 7.3%, 82.2%, and 40.8%, and no previous prenatal care was documented in 55.7%, 79.0%, and 62.4%, respectively. Among presentations with previous care, prenatal records were absent in 49.5%, 36.8%, and 34.9%, respectively. Anemia was most frequent among Black patients; urinary tract infection, sexually transmitted or blood-borne infection, and pregnancy loss were most frequent among Latin American patients. Urgent emergency department or labour and delivery referral and documented loss to follow-up were uncommon in all groups.
CONCLUSIONS: Demographic characteristics, access, documentation, and clinical needs differed across groups. Low-barrier, community-integrated midwifery pregnancy assessment may support planned referral, but comparative studies with linked perinatal outcomes are required.
METHODS: We conducted a retrospective descriptive chart review of pregnancy presentations assessed from July 1, 2013 to June 30, 2023. Race/ethnicity was self-reported at intake. Categorical variables were summarized as n/N (%) using variable-specific denominators and 95% CIs. Continuous variables were summarized as mean (SD). Three-group comparisons were descriptive rather than causal.
RESULTS: The cohort included 1170 pregnancy presentations: 245 Black patients, 471 Latin American patients, and 454 "all other" patients. Presentation at 14 weeks or later occurred in 63.8%, 34.1%, and 46.4%, respectively. Interpreter requirement was 7.3%, 82.2%, and 40.8%, and no previous prenatal care was documented in 55.7%, 79.0%, and 62.4%, respectively. Among presentations with previous care, prenatal records were absent in 49.5%, 36.8%, and 34.9%, respectively. Anemia was most frequent among Black patients; urinary tract infection, sexually transmitted or blood-borne infection, and pregnancy loss were most frequent among Latin American patients. Urgent emergency department or labour and delivery referral and documented loss to follow-up were uncommon in all groups.
CONCLUSIONS: Demographic characteristics, access, documentation, and clinical needs differed across groups. Low-barrier, community-integrated midwifery pregnancy assessment may support planned referral, but comparative studies with linked perinatal outcomes are required.