Racial disparity in previable birth

Area of Science:

• Perinatal epidemiology
• Maternal-fetal medicine
• Public health

Background:

• Extremely preterm birth before the limit of viability is rare but uniformly contributes to infant mortality due to neonatal death.
• Racial disparities exist in previable birth rates and their impact on infant mortality.

Purpose of the Study:

• Quantify racial differences in previable birth.
• Determine the contribution of previable births to infant mortality.
• Identify factors associated with live birth before the threshold of viability.

Main Methods:

• Population-based retrospective cohort study of live births in Ohio (2006-2012).
• Compared demographic, pregnancy, and delivery characteristics of previable births (16-22 weeks) with term births (37-42 weeks).
• Used logistic regression to calculate relative risk ratios for factors associated with previable birth.

Main Results:

• A significant racial disparity was observed, with black mothers having a 3- to 6-fold increased relative risk of previable birth.
• Factors associated with previable birth include black race, advanced maternal age, unmarried status, congenital anomalies, genetic disorders, prior preterm birth, and multifetal gestation.
• Previable births accounted for 28% of infant mortalities in white newborns and 45% in black infants.

Conclusions:

• Significant racial disparities in previable preterm births, predominantly spontaneous, contribute to racial differences in infant mortality.
• Targeted interventions for preventing spontaneous previable preterm birth are essential for reducing racial disparities in infant mortality.