Maternal and Child Health Journal

, Volume 3, Issue 4, pp 189–197 | Cite as

Racial Differences in the Patterns of Singleton Preterm Delivery in the 1988 National Maternal and Infant Health Survey

  • Cheryl Blackmore-Prince
  • Burney KiekeJr.
  • Krista A. Kugaraj
  • Cynthia Ferré
  • Laurie D. Elam-Evans
  • Cara J. Krulewitch
  • James A. Gaudino
  • Mary Overpeck

Abstract

Objectives: To determine if the association between race and preterm delivery would persist when preterm delivery was partitioned into two etiologic pathways. Methods: We evaluated perinatal and obstetrical data from the 1988 National Maternal and Infant Health Survey and classified preterm delivery as spontaneous or medically indicated. Discrete proportional hazard models were fit to assess the risk of preterm delivery for Black women compared with White women adjusting for potential demographic and behavioral confounding variables. Results: Preterm delivery occurred among 17.4% of Black births and 6.7% of White births with a Black versus White unadjusted hazard ratio (HR) of 2.8 (95% CI = 2.4−3.3). The adjusted HR for a medically indicated preterm delivery showed no racial difference in risk (HR = 1.0, 95% CI = 0.4−2.6). However, for spontaneous preterm delivery between 20 and 28 weeks gestation, the Black versus White adjusted hazard ratio (HR) was 4.9 (95% CI = 3.4−7.1). Conclusions: Although we found an increased unadjusted HR for preterm delivery among Black women compared with White women, the nearly fivefold increase in adjusted HR for the extremely preterm births and the absence of a difference for medically indicated preterm delivery was unexpected. Given the differences in the risks of preterm birth between Black and White women, we recommend to continue examining risk factors for preterm delivery after separating spontaneous from medically indicated preterm birth and subdividing preterm delivery by gestational age to shed light on the reasons for the racial disparity.

Epidemiology gestational age infant, premature pregnancy outcome preterm birth race 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Centers for Disease Control and Prevention, National Center for Health Statistics. Births and deaths: United States, 1996. Monthly Vital Statistics Report 1997;46(suppl):1–44.Google Scholar
  2. 2.
    Sowards KA. What is the leading cause of infant mortality? A note on the interpretation of official statistics. Am J Public Health 1999;89:1752–4.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention, National Center for Health Statistics. Advance report of final natality statistics, 1988. Monthly Vital Statistics Report 1990;39(suppl):1–48.Google Scholar
  4. 4.
    Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiol Rev 1993;15:414–43.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. Preterm singleton births—United States, 1989–1996. MMWR 1999;48:185–9.Google Scholar
  6. 6.
    Singh G, Yu SM. Infant mortality in the United States: trends, differentials, and projections, 1950–2010. Am J Public Health 1995;85:957–64.Google Scholar
  7. 7.
    Behrman RE. Premature births among Black women [editorial]. N Engl J Med 1987;317:763–5.Google Scholar
  8. 8.
    Hogue CJR, Yip R. Preterm delivery: can we lower the Black infant's first hurdle? JAMA 1989;262:548–50.Google Scholar
  9. 9.
    Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med 1987;317:743–8.Google Scholar
  10. 10.
    Shiono PH, Klebanoff MA. Ethnic differences in preterm and very preterm delivery. Am J Public Health 1986;76:1317–21.Google Scholar
  11. 11.
    McGrady GA, Sung JFC, Rowley DL, Hogue CJR. Preterm delivery and low birth weight among first-born infants of Black and White college graduates. Am J Epidemiol 1992;136:266–76.Google Scholar
  12. 12.
    Blackmore CA, Ferré CD, Rowley DL, Hogue CJR, Gaiter J, Atrash H. Is race a risk factor or a risk marker for preterm delivery? Ethnicity Dis 1993;3:372–7.Google Scholar
  13. 13.
    Freeman HP, President's Cancer Panel, National Cancer Institute. The meaning of race in science—considerations for cancer research. Cancer 1998;82:219–25.Google Scholar
  14. 14.
    Savitz DA, Blackmore CA, Thorp JM. Epidemiology of preterm delivery: etiologic heterogeneity. Am J Obstet Gynecol 1991;164:467–71.Google Scholar
  15. 15.
    Berkowitz GS, Blackmore-Prince C, Lapinski RH, Savitz DA. Risk factors for preterm birth subtypes. Epidemiology 1998;9:279–85.Google Scholar
  16. 16.
    Blackmore CA, Savitz DA, Edwards LJ, Harlow SD, Bowes WA. Racial differences in the patterns of preterm delivery in central North Carolina, USA. Paediatric Perinat Epidemiol 1995;9:281–95.Google Scholar
  17. 17.
    Harlow BL, Frigoletto FD, Cramer DW, Evans JK, LeFevre ML, Bain RP, et al. Determinants of preterm delivery in low-risk pregnancies. J Clin Epidemiol 1996;49:441–8.Google Scholar
  18. 18.
    Alexander GR. Preterm birth: etiology, mechanisms and prevention. Prenat Neonat Med 1998;3:3–9.Google Scholar
  19. 19.
    Klebanoff MA. Conceptualizing categories of preterm birth. Prenat Neonat Med 1998;3:13–15.Google Scholar
  20. 20.
    Klebanoff MA, Shiono PH. Top down, bottom up and inside out: reflections on preterm birth. Paediatric Perinat Epidemiol 1995;9:125–9.Google Scholar
  21. 21.
    National Center for Health Statistics. Public use data tape documentation 1988: National Maternal and Infant Health Survey. Hyattsville, MD: U.S. Department of Health and Human Services, 1991.Google Scholar
  22. 22.
    Sanderson M, Scott C, Gonzalez JF. 1988 National Maternal and Infant Health Survey: Methods and response characteristics. Vital and Health Statistics, Series 2, No. 125. National Center for Health Statistics, 1998.Google Scholar
  23. 23.
    Sanderson M, Placek PJ, Keppel KG. The 1988 national maternal and infant health survey: design, content, and da availability. Birth 1991;18:26–32.Google Scholar
  24. 24.
    Shah BV, Barnwell BG, Bieler GS. SUDAAN user's manual, release 7.0. Research Triangle Park, NC: Research Triangle Institute, 1996.Google Scholar
  25. 25.
    National Center for Health Statistics, Taffel S, Johnson D, Heuser R. A method of imputing length of gestation on birth certificates. Vital and Health Statistics, Series 2, No. 93. Pub. No. (PHS) 82-1367. Washington, DC: U.S. Government Printing Office, 1982.Google Scholar
  26. 26.
    Blackmore CA, Rowley DL, Kiely JL. Preterm birth. In: From data to action: CDC's public health surveillance for women, infants and children (pp. 179–83). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, 1994.Google Scholar
  27. 27.
    SAS Institute Inc. SAS/STAT user's guide, version 6, 4th ed., Vol. 2. Carry, NC: 1989.Google Scholar
  28. 28.
    Kleinbaum DG. Logistic regression: A self-learning text. New York: Springer-Verlag, 1994.Google Scholar
  29. 29.
    Adams MM, Read JA, Rawlings JS, Harlass FB, Sarno AP, Rhodes PH. Preterm delivery among Black and White enlisted women in the United States Army. Obstet Gynecol 1993;81:65–71.Google Scholar
  30. 30.
    Tucker JM, Goldenberg RL, Davis RO, Copper RL, Winkler CL, Hauth JC. Etiologies of preterm birth in an indigent population: is prevention a logical expectation? Obstet Gynecol 1991;77:343–7.Google Scholar
  31. 31.
    Allison, PD. Survival analysis using the SAS system: A pactical guide, Cary, NC: SAS Institute Inc., 1995.Google Scholar
  32. 32.
    Kramer MS, McLean FH, Boyd ME, Usher RH. The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. J. Am Med Assoc 1988;260:3306–8.Google Scholar
  33. 33.
    Rossavik IK, Fishburne JI. Conceptional age, menstrual age, and ultrasound age: a second-trimester comparison of pregnancies of known conception date with pregnancies dated from the last menstrual period. Obstet Gynecol 1989;73:243–9.Google Scholar
  34. 34.
    Goldenberg RL, Davis RO, Cutter GR, Hoffman HJ, Brumfield CG, Foster JM. Prematurity, postdates, and growth retardation: the influence of use of ultrasonography on reported gestational age. Am J Obstet Gynecol 1989;160:462–70.Google Scholar
  35. 35.
    Kiely JL. What is the population-based risk of preterm birth among twins and other multiples? Clin Obstet Gynecol 1998;41(1):3–11.Google Scholar
  36. 36.
    Allen MC, Amiel-Tison C, Alexander GR. Measurement of gestational age and maturity. Prenat Neonat Med 1998;3:56–9.Google Scholar
  37. 37.
    Hakim RB, Tielsch JM, See LC. Agreement between maternal interview and medical record-based gestational age. Am J Epidemiol 1992;136:566–73.Google Scholar
  38. 38.
    Emery III ES, Eaton A. Grether JK, Nelson KB. Assessment of gestational age using birth certificate data compared with medical record data. Paediatric Perinat Epidemiol 1997;11:313–21.Google Scholar
  39. 39.
    Alexander GR, de Caunes F, Hulsey TC, Tompkins ME, Allen M. Ethnic variation in postnatal assessments of gestational age: a reappraisal. Paediatric Perinat Epidemiol 1992;6:423–33.Google Scholar
  40. 40.
    Henricksen TB, Wilcox AJ, Hedegaard M, Secher NJ. Bias in studies of preterm and postterm delivery due to ultrasound assessment of gestational age. Epidemiology 1995;533–7.Google Scholar
  41. 41.
    Reuss ML, Hatch MC, Susser M. Early ultrasound dating of pregnancy selection and measurement biases. J Clin Epidemiol 1995;48(5):667–74.Google Scholar
  42. 42.
    Kempe A, Wise PH, Barkan SE, Sappenfield WM, Sachs B, Gortmaker SL, et al. Clinical determinants of the racial disparity in very low birth weight. N Engl J Med 1992;327:969–73.Google Scholar
  43. 43.
    Main DM, Gabbe SG, Richardson D, Strong S. Can preterm deliveries be prevented? Am J Obstet Gynecol 1985;151:892–8.Google Scholar
  44. 44.
    Herron MA, Katz M, Creasy RK. Evaluation of a preterm birth prevention program: Preliminary report. Obstet Gynecol 1981;59:452–6.Google Scholar
  45. 45.
    Gonik B, Creasy RK. Preterm labor: its diagnosis and management. Am J Obstet Gynecol 1986;154:3–8.Google Scholar
  46. 46.
    Berkowitz GS, Lapinski RH. Relative and attributable risk estimates for preterm birth. Prenat Neonat Med 1998;3:53–5.Google Scholar
  47. 47.
    Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL. Reduced incidence of preterm delivery and metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;333(26):1732–6.Google Scholar
  48. 48.
    Mercer BM, Arheart KL. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet 1995;346(8985):1271–9.Google Scholar
  49. 49.
    Gibbs RS, Eschenbach DA. Use of antibiotics to prevent preterm birth. Am J Obstet Gynecol 1997;177(2):375–80.Google Scholar
  50. 50.
    McGregor JA, French JI, Parker R, Draper D, Patterson E, Jones W, et al. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol 1995;173(1):157–66.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Cheryl Blackmore-Prince
    • 1
  • Burney KiekeJr.
    • 1
  • Krista A. Kugaraj
    • 1
  • Cynthia Ferré
    • 1
  • Laurie D. Elam-Evans
    • 1
  • Cara J. Krulewitch
    • 2
  • James A. Gaudino
    • 1
  • Mary Overpeck
    • 3
  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlanta
  2. 2.National Institute of Nursing Research, National Institutes of HealthBethesda
  3. 3.National Institute for Child Health and Human Development, National Institutes of HealthBethesda
  4. 4.Family Health Services DivisionHonolulu

Personalised recommendations