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Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality

Catherine L Kothari1, Camryn Romph2, Terra Bautista3

  • 1Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA. catherine.kothari@med.wmich.edu.

Maternal and Child Health Journal
|October 29, 2017
PubMed

Insights

Perinatal Periods of Risk (PPOR) analysis revealed Black women face excess mortality beyond poverty, primarily due to preterm births of very-low-birthweight infants. Maternal and prenatal factors significantly increase Black infant prematurity and low birthweight risks.

Area of Science:

  • Perinatal health
  • Health equity research
  • Maternal and child health

Background:

  • Racial and socioeconomic disparities in perinatal outcomes persist.
  • Understanding the distinct contributions of race and poverty to adverse birth outcomes is critical for targeted interventions.
  • The Perinatal Periods of Risk (PPOR) framework offers a method to dissect complex risk factors.

Purpose of the Study:

  • To differentiate risks associated with being Black from those associated with poverty using PPOR analysis.
  • To identify specific risk factors contributing to excess perinatal mortality and morbidity in Black populations.
  • To inform evidence-based strategies addressing racial inequity and socioeconomic disadvantage in perinatal health.

Main Methods:

  • Phase I PPOR compared Black and poor women/infants against a White, non-Hispanic reference group, and then against each other.
  • Phase II PPOR partitioned excess risk into very-low-birthweight risk and birthweight-specific mortality risk.
  • A novel subtraction of poverty-excess-PPOR from Black-excess-PPOR isolated Black-specific risks, controlling for poverty.

Main Results:

  • Black excess mortality was predominantly linked to the Maternal-Health/Prematurity category (67% of total excess mortality).
  • This excess mortality in Black populations was driven by premature deliveries of very-low-birthweight infants.
  • Black women experience significant excess mortality independent of poverty; vaginal bleeding, premature rupture of membranes, prior preterm delivery, and lack of prenatal care were key predictors of preterm delivery.

Conclusions:

  • PPOR is a valuable tool for standardizing risk assessment and focusing health promotion efforts.
  • Maternal preconception and prenatal factors significantly elevate the risk of prematurity and low birthweight for Black infants, largely unaffected by socioeconomic status.
  • Findings support integrated community-wide strategies to combat systematic racial inequity and socioeconomic disadvantage in perinatal health.

Keywords:
Kitagawa analysisPerinatal Periods of RiskRacial disparitiesSocioeconomic disparities

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