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Maternal race and intergenerational preterm birth recurrence.
Am J Obstet Gynecol. 2017 10; 217(4):480.e1-480.e9.AJ

Abstract

BACKGROUND

Preterm birth is a complex disorder with a heritable genetic component. Studies of primarily White women born preterm show that they have an increased risk of subsequently delivering preterm. This risk of intergenerational preterm birth is poorly defined among Black women.

OBJECTIVE

Our objective was to evaluate and compare intergenerational preterm birth risk among non-Hispanic Black and non-Hispanic White mothers.

STUDY DESIGN

This was a population-based retrospective cohort study, using the Virginia Intergenerational Linked Birth File. All non-Hispanic Black and non-Hispanic White mothers born in Virginia 1960 through 1996 who delivered their first live-born, nonanomalous, singleton infant ≥20 weeks from 2005 through 2009 were included. We assessed the overall gestational age distribution between non-Hispanic Black and White mothers born term and preterm (<37 weeks) and their infants born term and preterm (<37 weeks) using Cox regression and Kaplan-Meier survivor functions. Mothers were grouped by maternal gestational age at delivery (term, ≥37 completed weeks; late preterm birth, 34-36 weeks; and early preterm birth, <34 weeks). The primary outcomes were: (1) preterm birth among all eligible births; and (2) suspected spontaneous preterm birth among births to women with medical complications (eg, diabetes, hypertension, preeclampsia and thus higher risk for a medically indicated preterm birth). Multivariable logistic regression was used to estimate odds of preterm birth and spontaneous preterm birth by maternal race and maternal gestational age after adjusting for confounders including maternal education, maternal age, smoking, drug/alcohol use, and infant gender.

RESULTS

Of 173,822 deliveries captured in the intergenerational birth cohort, 71,676 (41.2%) women met inclusion criteria for this study. Of the entire cohort, 30.0% (n = 21,467) were non-Hispanic Black and 70.0% were non-Hispanic White mothers. Compared to non-Hispanic White mothers, non-Hispanic Black mothers were more likely to have been born late preterm (6.8% vs 3.7%) or early preterm (2.8 vs 1.0%), P < .001. Non-Hispanic White mothers who were born (early or late) preterm were not at an increased risk of early or late preterm delivery compared to non-Hispanic White mothers born term. The risk of early preterm birth was most pronounced for Black mothers who were born early preterm (adjusted odds ratio, 3.26; 95% confidence interval, 1.77-6.02) compared to non-Hispanic White mothers.

CONCLUSION

We found an intergenerational effect of preterm birth among non-Hispanic Black mothers but not non-Hispanic White mothers. Black mothers born <34 weeks carry the highest risk of delivering their first child very preterm. Future studies should elucidate the underlying pathways leading to this racial disparity.

Authors+Show Affiliations

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT. Electronic address: Marcela.Smid@hsc.utah.edu.Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA.Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC.Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC.Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT.Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA.Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28578169

Citation

Smid, Marcela C., et al. "Maternal Race and Intergenerational Preterm Birth Recurrence." American Journal of Obstetrics and Gynecology, vol. 217, no. 4, 2017, pp. 480.e1-480.e9.
Smid MC, Lee JH, Grant JH, et al. Maternal race and intergenerational preterm birth recurrence. Am J Obstet Gynecol. 2017;217(4):480.e1-480.e9.
Smid, M. C., Lee, J. H., Grant, J. H., Miles, G., Stoddard, G. J., Chapman, D. A., & Manuck, T. A. (2017). Maternal race and intergenerational preterm birth recurrence. American Journal of Obstetrics and Gynecology, 217(4), e1-e9. https://doi.org/10.1016/j.ajog.2017.05.051
Smid MC, et al. Maternal Race and Intergenerational Preterm Birth Recurrence. Am J Obstet Gynecol. 2017;217(4):480.e1-480.e9. PubMed PMID: 28578169.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal race and intergenerational preterm birth recurrence. AU - Smid,Marcela C, AU - Lee,Jong Hyung, AU - Grant,Jacqueline H, AU - Miles,Gandarvaka, AU - Stoddard,Gregory J, AU - Chapman,Derek A, AU - Manuck,Tracy A, Y1 - 2017/05/31/ PY - 2017/03/03/received PY - 2017/05/16/revised PY - 2017/05/22/accepted PY - 2017/6/5/pubmed PY - 2017/10/3/medline PY - 2017/6/5/entrez KW - health disparity KW - intergenerational recurrence KW - perinatal epidemiology KW - preterm birth KW - racial disparity SP - 480.e1 EP - 480.e9 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 217 IS - 4 N2 - BACKGROUND: Preterm birth is a complex disorder with a heritable genetic component. Studies of primarily White women born preterm show that they have an increased risk of subsequently delivering preterm. This risk of intergenerational preterm birth is poorly defined among Black women. OBJECTIVE: Our objective was to evaluate and compare intergenerational preterm birth risk among non-Hispanic Black and non-Hispanic White mothers. STUDY DESIGN: This was a population-based retrospective cohort study, using the Virginia Intergenerational Linked Birth File. All non-Hispanic Black and non-Hispanic White mothers born in Virginia 1960 through 1996 who delivered their first live-born, nonanomalous, singleton infant ≥20 weeks from 2005 through 2009 were included. We assessed the overall gestational age distribution between non-Hispanic Black and White mothers born term and preterm (<37 weeks) and their infants born term and preterm (<37 weeks) using Cox regression and Kaplan-Meier survivor functions. Mothers were grouped by maternal gestational age at delivery (term, ≥37 completed weeks; late preterm birth, 34-36 weeks; and early preterm birth, <34 weeks). The primary outcomes were: (1) preterm birth among all eligible births; and (2) suspected spontaneous preterm birth among births to women with medical complications (eg, diabetes, hypertension, preeclampsia and thus higher risk for a medically indicated preterm birth). Multivariable logistic regression was used to estimate odds of preterm birth and spontaneous preterm birth by maternal race and maternal gestational age after adjusting for confounders including maternal education, maternal age, smoking, drug/alcohol use, and infant gender. RESULTS: Of 173,822 deliveries captured in the intergenerational birth cohort, 71,676 (41.2%) women met inclusion criteria for this study. Of the entire cohort, 30.0% (n = 21,467) were non-Hispanic Black and 70.0% were non-Hispanic White mothers. Compared to non-Hispanic White mothers, non-Hispanic Black mothers were more likely to have been born late preterm (6.8% vs 3.7%) or early preterm (2.8 vs 1.0%), P < .001. Non-Hispanic White mothers who were born (early or late) preterm were not at an increased risk of early or late preterm delivery compared to non-Hispanic White mothers born term. The risk of early preterm birth was most pronounced for Black mothers who were born early preterm (adjusted odds ratio, 3.26; 95% confidence interval, 1.77-6.02) compared to non-Hispanic White mothers. CONCLUSION: We found an intergenerational effect of preterm birth among non-Hispanic Black mothers but not non-Hispanic White mothers. Black mothers born <34 weeks carry the highest risk of delivering their first child very preterm. Future studies should elucidate the underlying pathways leading to this racial disparity. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28578169/Maternal_race_and_intergenerational_preterm_birth_recurrence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(17)30680-4 DB - PRIME DP - Unbound Medicine ER -