{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:03:52Z","timestamp":1791893032258,"version":"4.3.4"},"reference-count":100,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Equity"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Stigmatizing language represents biases. Understanding its impact is crucial to improve perinatal health. We aimed to examine the association between stigmatizing language in electronic health records (EHR) and birth outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We analyzed EHR data of patients admitted for childbirth (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 18,897) between 2017 and 2019 using natural language processing at two hospitals in the United States. Independent variables were any stigmatizing language, and by category: marginalized language\/identities, difficult patient, and unilateral\/authoritarian decisions. Outcome variables included low-risk cesarean birth (Society for Maternal and Fetal Medicine [SMFM] and nulliparous, term, singleton, vertex [NTSV] definitions), postpartum hemorrhage, and chorioamnionitis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared with patients with no stigmatizing language, patients with any stigmatizing language had higher odds of SMFM low-risk cesarean birth (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.23\u20131.50,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), postpartum hemorrhage (aOR = 1.68, 95% CI = 1.51\u20131.88,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), and chorioamnionitis (aOR = 1.23, 95% CI = 1.07\u20131.42,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01). Labeling patients as difficult was associated with higher odds of low-risk cesarean birth (SMFM aOR = 1.19, 95% CI = 1.07\u20131.33,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), postpartum hemorrhage (aOR = 2.07, 95% CI = 1.85\u20132.30,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), and chorioamnionitis (aOR = 1.33, 95% CI = 1.14\u20131.55,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01). Patients who had language from unilateral\/authoritarian category had higher odds of low-risk cesarean birth (SMFM aOR = 1.46, 95% CI = 1.31\u20131.62,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01) and postpartum hemorrhage (aOR = 1.31, 95% CI = 1.17\u20131.46,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusion:<\/jats:title>\n                    <jats:p>Stigmatizing language in clinical notes was associated with birth outcomes. These findings highlight the need to improve perinatal health through examining individual behaviors and structural-level policies that reinforce bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24731242251381595","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T15:52:07Z","timestamp":1758815527000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Documentation of Stigmatizing Language in Electronic Health Records and Birth Outcomes"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0864-7867","authenticated-orcid":false,"given":"Jihye Kim","family":"Scroggins","sequence":"first","affiliation":[{"name":"School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismael Ibrahim","family":"Hulchafo","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Harkins","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Moen","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Aalto University, Espoo, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Tadiello","sequence":"additional","affiliation":[{"name":"Center for Community-Engaged Health Informatics and Data Science, Columbia University Irving Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenrick","family":"Cato","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anahita","family":"Davoudi","sequence":"additional","affiliation":[{"name":"VNS Health, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice James","family":"Aubey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coretta","family":"Green","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Hospitals, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Topaz","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3070-1716","authenticated-orcid":false,"given":"Veronica","family":"Barcelona","sequence":"additional","affiliation":[{"name":"Columbia University School of Nursing, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-213"},{"key":"e_1_3_5_3_2","article-title":"Maternal mortality rates in the United States, 2022","author":"Hoyert D","year":"2024","unstructured":"Hoyert D. 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