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Racial differences in the patterns of singleton preterm delivery in the 1988 National Maternal and Infant Health
C Blackmore-Prince1, B Kieke, K A Kugaraj
1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. CAB5@CDC.GOV
Maternal and Child Health Journal
|May 3, 2000
Summary
Racial disparities in preterm birth exist, with spontaneous preterm births occurring more frequently in Black women. Medically indicated preterm births showed no racial difference. Further research is needed to understand these disparities.
Area of Science:
- Perinatal epidemiology
- Reproductive health disparities
- Maternal-fetal medicine
Background:
- Racial disparities in preterm birth rates are a significant public health concern.
- Understanding the etiologic pathways of preterm delivery is crucial for addressing these disparities.
Purpose of the Study:
- To investigate whether the association between race and preterm delivery differs when considering spontaneous versus medically indicated preterm births.
- To assess the adjusted risk of preterm delivery for Black women compared to White women within these distinct pathways.
Main Methods:
- Analysis of perinatal and obstetrical data from the 1988 National Maternal and Infant Health Survey.
- Classification of preterm delivery into spontaneous and medically indicated categories.
- Use of discrete proportional hazard models to assess racial differences in risk, adjusting for confounding variables.
Main Results:
- Black women had a higher unadjusted risk of preterm delivery (17.4%) compared to White women (6.7%).
- No significant racial difference in risk was observed for medically indicated preterm deliveries (adjusted HR = 1.0).
- A nearly fivefold increased adjusted risk of spontaneous preterm delivery between 20 and 28 weeks gestation was found for Black women compared to White women (adjusted HR = 4.9).
Conclusions:
- The study highlights that the increased risk of preterm birth for Black women is primarily driven by spontaneous preterm deliveries, particularly extreme preterm births.
- The absence of a racial disparity in medically indicated preterm deliveries suggests different underlying mechanisms.
- Further research is recommended to explore risk factors by separating spontaneous from medically indicated preterm births and by gestational age to elucidate the reasons for racial disparities.