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Racial/ethnic differences in preterm perinatal outcomes.
Am J Obstet Gynecol. 2017 Mar; 216(3):306.e1-306.e12.AJ

Abstract

BACKGROUND

Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation.

OBJECTIVE

The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race.

STUDY DESIGN

A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined.

RESULTS

Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms.

CONCLUSION

Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities.

Authors+Show Affiliations

Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD. Electronic address: katherine.grantz@nih.gov.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27865977

Citation

Wallace, Maeve E., et al. "Racial/ethnic Differences in Preterm Perinatal Outcomes." American Journal of Obstetrics and Gynecology, vol. 216, no. 3, 2017, pp. 306.e1-306.e12.
Wallace ME, Mendola P, Kim SS, et al. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol. 2017;216(3):306.e1-306.e12.
Wallace, M. E., Mendola, P., Kim, S. S., Epps, N., Chen, Z., Smarr, M., Hinkle, S. N., Zhu, Y., & Grantz, K. L. (2017). Racial/ethnic differences in preterm perinatal outcomes. American Journal of Obstetrics and Gynecology, 216(3), e1-e12. https://doi.org/10.1016/j.ajog.2016.11.1026
Wallace ME, et al. Racial/ethnic Differences in Preterm Perinatal Outcomes. Am J Obstet Gynecol. 2017;216(3):306.e1-306.e12. PubMed PMID: 27865977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial/ethnic differences in preterm perinatal outcomes. AU - Wallace,Maeve E, AU - Mendola,Pauline, AU - Kim,Sung Soo, AU - Epps,Nikira, AU - Chen,Zhen, AU - Smarr,Melissa, AU - Hinkle,Stefanie N, AU - Zhu,Yeyi, AU - Grantz,Katherine L, Y1 - 2016/11/16/ PY - 2016/08/26/received PY - 2016/10/26/revised PY - 2016/11/09/accepted PY - 2016/11/21/pubmed PY - 2017/6/8/medline PY - 2016/11/21/entrez KW - intracranial hemorrhage KW - intraventricular hemorrhage KW - necrotizing enterocolitis KW - neonatal death KW - perinatal death KW - preterm birth KW - respiratory distress syndrome KW - retinopathy of prematurity KW - sepsis KW - transient tachypnea SP - 306.e1 EP - 306.e12 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 216 IS - 3 N2 - BACKGROUND: Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation. OBJECTIVE: The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race. STUDY DESIGN: A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined. RESULTS: Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms. CONCLUSION: Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/27865977/Racial/ethnic_differences_in_preterm_perinatal_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(16)32042-7 DB - PRIME DP - Unbound Medicine ER -