The association between higher body weight and stigmatizing language documented in hospital birth admission notes

Weight stigma is pervasive in pregnancy care. However, there is limited research on how pregnant women with higher body weight experience stigma through language documented in electronic health records (EHR). The purpose of this study was to examine the association between higher body weight and stigmatizing language documented in the EHR during the hospital birth admission.

We used EHR data from women over 20 weeks of gestation admitted to two large metropolitan hospitals in the Northeast United States between 2017 and 2019. The primary exposure was higher body weight. We identified women with higher body weight with ICD-10 codes and keyword searches for terms associated with higher body weight in clinical notes. Study outcomes were the presence of any stigmatizing language and four subcategories of stigmatizing language documented in the clinical note. We employed logistic regression to calculate unadjusted and adjusted associations.

After adjusting for covariates, women with higher body weight were more likely to have any stigmatizing language documented compared to women without higher body weight in birth hospitalization notes (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI] = 1.01, 1.20). Women with higher body weight were also more likely to have language documented from the marginalized language/identities category (aOR = 1.38, 95% CI = 1.20, 1.59).

Women with higher body weight experience stigma in clinical documentation. Findings support the need for clinician training in equitable documentation and the removal of stigmatizing terms from clinic documents and workflows to promote perinatal health equity.