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Disproportionate Preterm Delivery Among Black Women: a State-Level Analysis

  • Palmira SantosEmail author
  • Gitanjali Joglekar
  • Kristen Faughnan
  • Jennifer Darden
  • Ann Hendrich
Article
  • 10 Downloads

Abstract

Preterm delivery occurs at extraordinarily higher rates among Black women than among women of any other race or ethnicity. For those children who survive, many face a lifetime of health and developmental challenges as well as difficulties in school and life. Previous studies have provided substantive evidence that the preterm delivery disparity experienced by Black women is associated with ongoing distress caused by racism. Our study examines rates of preterm delivery for Black women in the USA to determine the level of risk associated with living in specific states. Using a logistic regression model, we examined the impact of the delivery state, controlling for known clinical, economic, and demographic risk factors. We found that 32 of the 35 states included in our analysis were associated with a statistically significantly increased risk of preterm delivery among Black women, as compared to the state with the lowest preterm delivery rate for Black women. These findings allowed us to organize states into a continuum of preterm delivery risk. Because of the harmful effects of preterm delivery and its disproportionate impact among Black women and infants, we recommend that a measure of preterm delivery be included in any state plan to assess, intervene in, and monitor racial disparities.

Keywords

Labor and delivery Disparities Preterm delivery Social determinants of health MSC Codes: 92-02: Research exposition (monographs, survey articles), Biology and other natural sciences 

Notes

Acknowledgments

The authors would like to thank the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics for providing the data used in this study.

Author Contribution

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Palmira Santos, Gitanjali Joglekar, and Kristen Faughnan. The first draft of the manuscript was written by Palmira Santos, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval was not required for this retrospective study. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Formal consent is not required for this type of study.

Supplementary material

40615_2019_657_MOESM1_ESM.pdf (250 kb)
Online Resource 1: Deliveries and Preterm Birth Rates by Race and State. Descriptive Caption: Online Resource 1 provides full state-level descriptive results. The leftmost column lists the state name. The second and third columns list, respectively, the total number of deliveries in the state and the percent of those deliveries that were preterm. The fourth and fifth columns list the same information for Black women only, while the sixth and seventh columns list this information for non-Black women. Finally, the eighth column lists the unadjusted risk ratio for preterm birth for Black women relative to non-Black women in the designated state. A footnote indicates that the table includes only singleton live births that had a gestational age of at least 20 weeks, took place in 2016, had complete data for all study variables, occurred in a hospital, and were paid for by either Medicaid or a private insurer. (PDF 250 kb)
40615_2019_657_MOESM2_ESM.pdf (239 kb)
Online Resource 2: State Odds Ratios for Preterm Delivery (Deliveries among Non-Black Women). Descriptive Caption: Online Resource 2 provides state odds ratios for preterm birth among non-Black women. The first column lists the state name. The second column lists the state odds ratio (OR) and 95% confidence interval (CI). A footnote indicates that results are adjusted for maternal age, payer type, maternal hypertension, maternal diabetes, pre-pregnancy obesity, and smoking during pregnancy, and that the reference state is Oregon. (PDF 239 kb)

References

  1. 1.
    Bediako PT, BeLue R, Hillemeier MM. A comparison of birth outcomes among Black, Hispanic, and Black Hispanic women. J Racial Ethn Health Disparities. 2015;2:573–82.  https://doi.org/10.1007/s40615-015-0110-2.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Braveman P, Heck K, Egerter S, Dominguez TP, Rinki C, Marchi KS, et al. Worry about racial discrimination: a missing piece of the puzzle of Black-White disparities in preterm birth? PLoS One. 2017.  https://doi.org/10.1371/journal.pone.0186151.CrossRefGoogle Scholar
  3. 3.
    Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018.  https://doi.org/10.1001/jamapediatrics.2018.2029.CrossRefGoogle Scholar
  4. 4.
    March of Dimes. 2018 premature birth report card: United States. March of Dimes. 2018. https://www.marchofdimes.org/materials/PrematureBirthReportCard-United%20States-2018.pdf. Accessed 5 September 2019
  5. 5.
    ACOG. Committee Opinion No 579: Definition of term pregnancy. Obstet Gynecol. 2013.  https://doi.org/10.1097/01.AOG.0000437385.88715.4a.
  6. 6.
    American College of Obstetricians and Gynecologists. Preterm labor and birth (FAQ087). American College of Obstetricians and Gynecologists. 2019. https://www.acog.org/Patients/FAQs/Preterm-Labor-and-Birth. Accessed 30 July 2019
  7. 7.
    Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016.  https://doi.org/10.1016/s0140-6736(16)31593-8.CrossRefGoogle Scholar
  8. 8.
    Raju TNK, Buist AS, Blaisdell CJ, Moxey-Mims M, Saigal S. Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr. 2017.  https://doi.org/10.1111/apa.13880.CrossRefGoogle Scholar
  9. 9.
    Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol. 2016.  https://doi.org/10.1055/s-0035-1571150.CrossRefGoogle Scholar
  10. 10.
    Luu TM, Rehman Mian MO, Nuyt AM. Long-term impact of preterm birth: neurodevelopmental and physical health outcomes. Clin Perinatol. 2017.  https://doi.org/10.1016/j.clp.2017.01.003.CrossRefGoogle Scholar
  11. 11.
    Nuyt AM, Lavoie JC, Mohamed I, Paquette K, Luu TM. Adult consequences of extremely preterm birth: cardiovascular and metabolic diseases risk factors, mechanisms, and prevention avenues. Clin Perinatol. 2017.  https://doi.org/10.1016/j.clp.2017.01.010.CrossRefGoogle Scholar
  12. 12.
    Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017.  https://doi.org/10.1016/s0140-6736(17)30569-x.CrossRefGoogle Scholar
  13. 13.
    Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018.  https://doi.org/10.1016/j.bpobgyn.2018.04.003.CrossRefGoogle Scholar
  14. 14.
    Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008.  https://doi.org/10.1016/s0140-6736(08)60074-4.CrossRefGoogle Scholar
  15. 15.
    Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012.  https://doi.org/10.1016/j.siny.2012.01.007.CrossRefGoogle Scholar
  16. 16.
    Koullali B, Oudijk MA, Nijman TA, Mol BW, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med. 2016.  https://doi.org/10.1016/j.siny.2016.01.005.CrossRefGoogle Scholar
  17. 17.
    Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;  https://doi.org/10.1097/AOG.0b013e3182723b1b
  18. 18.
    Hogan VK, Rowley D, Bennett T, Taylor KD. Life course, social determinants, and health inequities: toward a national plan for achieving health equity for African American infants--a concept paper. Matern Child Health J. 2012;16:1143–50.  https://doi.org/10.1007/s10995-011-0847-0.CrossRefPubMedGoogle Scholar
  19. 19.
    Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res. 2016;79:141–7.  https://doi.org/10.1038/pr.2015.199.CrossRefPubMedGoogle Scholar
  20. 20.
    Giurgescu C, Zenk SN, Templin TN, Engeland CG, Kavanaugh K, Misra DP. The impact of neighborhood conditions and psychological distress on preterm birth in African-American women. Public Health Nurs. 2017.  https://doi.org/10.1111/phn.12305.CrossRefGoogle Scholar
  21. 21.
    Ncube CN, Enquobahrie DA, Burke JG, Ye F, Marx J, Albert SM. Transgenerational transmission of preterm birth risk: the role of race and generational socio-economic neighborhood context. Matern Child Health J. 2017;21:1616–26.  https://doi.org/10.1007/s10995-016-2251-2.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Slaughter-Acey JC, Sealy-Jefferson S, Helmkamp L, Caldwell CH, Osypuk TL, Platt RW, et al. Racism in the form of micro aggressions and the risk of preterm birth among black women. Ann Epidemiol. 2016.  https://doi.org/10.1016/j.annepidem.2015.10.005.CrossRefGoogle Scholar
  23. 23.
    Orchard J, Price J. County-level racial prejudice and the black-white gap in infant health outcomes. Soc Sci Med. 2017.  https://doi.org/10.1016/j.socscimed.2017.03.036.CrossRefGoogle Scholar
  24. 24.
    Giurgescu C, Misra DP. Psychosocial factors and preterm birth among Black mothers and fathers. MCN Am J Matern Child Nurs. 2018.  https://doi.org/10.1097/nmc.0000000000000458.CrossRefGoogle Scholar
  25. 25.
    Sørbye IK, Wanigaratne S, Urquia ML. Variations in gestational length and preterm delivery by race, ethnicity and migration. Best Pract Res Clin Obstet Gynaecol. 2016.  https://doi.org/10.1016/j.bpobgyn.2015.08.017.CrossRefGoogle Scholar
  26. 26.
    Elo IT, Vang Z, Culhane JF. Variation in birth outcomes by mother’s country of birth among non-Hispanic black women in the United States. Matern Child Health J. 2014;18:2371–81.  https://doi.org/10.1007/s10995-014-1477-0.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Oliver EA, Klebanoff M, Yossef-Salameh L, Oza-Frank R, Moosavinasab S, Reagan P, et al. Preterm birth and gestational length in four race-nativity groups, including Somali Americans. Obstet Gynecol. 2018.  https://doi.org/10.1097/aog.0000000000002427.CrossRefGoogle Scholar
  28. 28.
    National Center for Health Statistics. Natality limited geography file (2016), as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative ProgramGoogle Scholar
  29. 29.
    Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr. 2003.  https://doi.org/10.1186/1471-2431-3-6.
  30. 30.
    American Public Health Association. Reducing racial/ethnic and socioeconomic disparities in preterm and low birthweight births (Policy No. 20062). American Public Health Association. 2006. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/18/10/01/reducing-racial-ethnic-and-socioeconomic-disparities-in-preterm-and-low-birthweight-births. Accessed 30 July 2019.
  31. 31.
    Burris HH, Hacker MR. Birth outcome racial disparities: a result of intersecting social and environmental factors. Semin Perinatol. 2017.  https://doi.org/10.1053/j.semperi.2017.07.002.CrossRefGoogle Scholar
  32. 32.
    Krieger N, Chen JT, Coull B, Waterman PD, Beckfield J. The unique impact of abolition of Jim Crow laws on reducing inequities in infant death rates and implications for choice of comparison groups in analyzing societal determinants of health. Am J Public Health. 2013.  https://doi.org/10.2105/ajph.2013.301350.CrossRefGoogle Scholar
  33. 33.
    Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008.  https://doi.org/10.1016/s0140-6736(08)61690-6.CrossRefGoogle Scholar
  34. 34.
    Powell JA. Structural racism: building upon the insights of John Calmore. N C L Rev. 2007;86:791–816.Google Scholar
  35. 35.
    Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014.  https://doi.org/10.1016/j.socscimed.2013.07.021.CrossRefGoogle Scholar
  36. 36.
    Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5.CrossRefGoogle Scholar
  37. 37.
    Alio AP, Richman AR, Clayton HB, Jeffers DF, Wathington DJ, Salihu HM. An ecological approach to understanding black-white disparities in perinatal mortality. Matern Child Health J. 2010;14:557–66.  https://doi.org/10.1007/s10995-009-0495-9.CrossRefPubMedGoogle Scholar
  38. 38.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009.  https://doi.org/10.1007/s10865-008-9185-0.CrossRefGoogle Scholar
  39. 39.
    Hernandez VR, Montana S, Clarke K. Child health inequality: framing a social work response. Health Soc Work. 2010;35(4):291–301.CrossRefGoogle Scholar
  40. 40.
    Adelman L, Cheng J. RACE - the power of an illusion. San Francisco: California Newsreel; 2003.Google Scholar
  41. 41.
    Rankin KM, David RJ, Collins JW Jr. African American women’s exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethn Dis. 2011;21(3):370–6.PubMedGoogle Scholar
  42. 42.
    Collins JW Jr, David RJ, Handler A, Wall S, Andes S. Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. Am J Public Health. 2004;94(12):2132–8.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Brandeis UniversityWalthamUSA
  2. 2.AlabasterUSA
  3. 3.St. LouisUSA

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