Racial and ethnic disparities in early cervical length screening and spontaneous preterm birth

Racial and ethnic disparities in preterm birth (PTB) persist despite advances in prevention. Cervical length screening and cerclage placement are established strategies for reducing recurrent spontaneous PTB (sPTB), yet it remains unclear whether access to and use of these interventions differ by race and ethnicity or contribute to observed disparities in outcomes.

To evaluate racial and ethnic differences in early cervical length screening, cerclage placement, and PTB outcomes among patients with a history of sPTB.

This retrospective cohort study included patients with two deliveries between January 2019 and December 2024 within a large academic health system. The first delivery resulted in an sPTB, and the second was used to evaluate preventive care and outcomes. The primary exposures were self-reported race and ethnicity; the primary outcomes were early cervical length screening, cerclage placement, and sPTB in the subsequent pregnancy. Early cervical length screening was defined as having at least one cervical length measurement obtained via transvaginal ultrasound between 16 0/7 and 18 6/7 weeks of gestation. Multivariable logistic regression was used to assess associations after adjustment for sociodemographic and clinical factors, including obstetric comorbidity index score, prior sPTB<34 weeks, public insurance, and preferred language.

In total, 924 patients were included for analysis. Overall, 31.5% (n=291) of patients underwent early cervical length screening, and 8.0% (n=74) received a cerclage. Non-Hispanic Black patients were more likely to receive early screening than non-Hispanic White patients (aOR 1.84, 95% CI 1.17-2.87) and had higher odds of cerclage placement (aOR 5.67, 95% CI 2.69-12.74). Patients with an index sPTB<34 weeks were significantly more likely to undergo early screening (aOR 2.85, 95% CI 2.07-3.93) and cerclage placement (aOR 10.76, 95% CI 5.83-21.27). Non-Hispanic Black patients also had higher odds of short cervix compared with non-Hispanic White patients (aOR 3.23, 95% CI 1.17-9.91). Across the full cohort, PTB occurred in 26.1% of deliveries, with higher rates among non-Hispanic Black than non-Hispanic White patients (33.6% vs 17.4%; aOR 1.70, 95% CI 1.05-2.43). However, among patients who received early cervical length screening, rates of preterm and sPTB were similar across racial and ethnic groups.

Racial and ethnic differences were identified in early cervical length screening and cerclage placement among patients with a history of sPTB. These differences did not translate into disparities in PTB outcomes when early screening and indicated intervention were performed. Consistent and equitable implementation of evidence-based screening and treatment may help reduce racial and ethnic disparities in PTB among high-risk patients. El resumen está disponible en Español al final del artículo.