The differential effects of maternal age, race/ethnicity and insurance on neonatal intensive care unit admission rates
Maternal race/ethnicity, age, and socioeconomic status (SES) are important factors determining birth outcome. Previous studies have demonstrated that, teenagers, and mothers with advanced maternal age (AMA), and Black/Non-Hispanic race/ethnicity can independently increase the risk for a poor pregnancy outcome. Similarly, public insurance has been associated with suboptimal health outcomes. The interaction and impact on the risk of a pregnancy resulting in a NICU admission has not been studied. Our aim was, to analyze the simultaneous interactions of teen/advanced maternal age (AMA), race/ethnicity and socioeconomic status on the odds of NICU admission.
The Consortium of Safe Labor Database (subset of n = 167,160 live births) was used to determine NICU admission and maternal factors: age, race/ethnicity, insurance, previous c-section, and gestational age.
AMA mothers were more likely than teenaged mothers to have a pregnancy result in a NICU admission. Black/Non-Hispanic mothers with private insurance had increased odds for NICU admission. This is in contrast to the lower odds of NICU admission seen with Hispanic and White/Non-Hispanic pregnancies with private insurance.
Private insurance is protective against a pregnancy resulting in a NICU admission for Hispanic and White/Non-Hispanic mothers, but not for Black/Non-Hispanic mothers. The health disparity seen between Black and White/Non-Hispanics for the risk of NICU admission is most evident among pregnancies covered by private insurance. These study findings demonstrate that adverse pregnancy outcomes are mitigated differently across race, maternal age, and insurance status.
- Schempf AH, Branum AM, Lukacs SL, Schoendorf KC: Maternal age and parity-associated risks of preterm birth: differences by race/ethnicity. Paediatr Perinat Epidemiol 2007,21(1):34–43. CrossRef
- Holzman C, Eyster J, Kleyn M, Messer LC, Kaufman JS, Laraia BA, O'Campo P, Burke JG, Culhane J, Elo IT: Maternal weathering and risk of preterm delivery. Am J Public Health 2009,99(10):1864–1871. CrossRef
- Love C, David RJ, Rankin KM, Collins JW Jr: Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women. Am J Epidemiol 2010,172(2):127–134. CrossRef
- Geronimus AT: The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis 1992,2(3):207–221.
- Hogue CJ, Bremner JD: Stress model for research into preterm delivery among black women. Am J Obstet Gynecol 2005,192(5 Suppl):S47–55. CrossRef
- Mathews TJ, Menacker F, MacDorman MF: Infant Mortality statistics from the 2001 period linked birth/infant death data set, vol. 52. CDC; 2003:1–28.
- Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE: Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med 2006,63(12):3030–3045. CrossRef
- Pickett KE, Collins JW Jr, Masi CM, Wilkinson RG: The effects of racial density and income incongruity on pregnancy outcomes. Soc Sci Med 2005,60(10):2229–2238. CrossRef
- Collins JW Jr, David RJ, Simon DM, Prachand NG: Preterm birth among African American and white women with a lifelong residence in high-income Chicago neighborhoods: an exploratory study. Ethn Dis 2007,17(1):113–117.
- Osypuk TL, Acevedo-Garcia D: Are racial disparities in preterm birth larger in hypersegregated areas? Am J Epidemiol 2008,167(11):1295–1304. CrossRef
- Geronimus AT, Hicken M, Keene D, Bound J: "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health 2006,96(5):826–833. CrossRef
- Brown HL, Chireau MV, Jallah Y, Howard D: The "Hispanic paradox": an investigation of racial disparity in pregnancy outcomes at a tertiary care medical center. Am J Obstet Gynecol 2007,197(2):197. e1; Aug-197.e7 CrossRef
- McGlade MS, Saha S, Dahlstrom ME: The Latina paradox: an opportunity for restructuring prenatal care delivery. Am J Public Health 2004,94(12):2062–2065. CrossRef
- CDC: 2009 Assisted Reproductive Technology, Success Rates: National Summary and Fertility Clinic Reports. 2011.
- Gray J, McCormick M, Richardson D, Ringer S: Normal birth weight intensive care unit survivors: outcome assessment. Pediatrics 1996,97(6):832–833. 838
- Muraskas J, Parsi K: The cost of saving the tiniest lives: NICUs versus prevention. Virtual Mentor 10(10): 07/01/2011
- Behrman RE, Stitch Butler A: Preterm birth: causes, consequences, and prevention. Washington: National Academies Press; 2007:398.
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/12/97/prepub
- The differential effects of maternal age, race/ethnicity and insurance on neonatal intensive care unit admission rates
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Pregnancy and Childbirth
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Department of Neonatal-Perinatal Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- 5. Division of Neonatal-Perinatal Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- 2. Department of Neonatology, Christiana Care Health System, Newark, DE, USA
- 3. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
- 4. Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA