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Cervical pathways for racial disparities in preterm births: the Preterm Prediction Study.
J Matern Fetal Neonatal Med. 2019 Dec; 32(23):4022-4028.JM

Abstract

Purpose:

Racial disparities in preterm birth have been long recognized, but the social and biological mechanisms for these differences are unclear. Our analysis had three goals: (1) to determine the relation between race and other social risk factors and cervical structure; (2) to determine whether social factors mediate the relation between race and cervical structure; and (3) to determine whether racial disparities in preterm birth (PTB) are mediated through changes in cervical structure observed earlier in pregnancy. Materials and methods: Data from the Maternal Fetal Medicine Unit network Preterm Prediction Study were used to examine the relation between race and other social factors and cervical properties throughout pregnancy in 2920 black and white women. Outcomes included cervical length and dilation; cervical score (cervical length-internal dilation); and whether membranes protruded at 22-24 and 26-29 weeks. Race, education, income, insurance type, and marital status were examined as predictors of the outcomes using linear and logistic regression, adjusting for age, BMI, parity, and smoking. Mediation analysis was used to examine whether (a) any social factors explained racial differences in cervical properties, and (b) whether cervical properties mediated racial differences in risk for preterm birth.

Results:

Shorter cervical length, especially at a subject's first visit, was associated with black race (adjusted beta -1.56 mm, p < .01) and lower income (adjusted beta -1.48, p =.05). External dilation was not associated with social factors, while internal dilation was associated with black race and lower education. Black race and marital status were associated with lower cervical score. There was no evidence of mediation of the racial effect on cervical properties by any social factor. Shorter cervical length, dilation, and score were all associated with preterm birth (p < .01). Mediation analysis indicated that each of these mediated the effect of race, but explained a small proportion of the total effect (15-25%).

Conclusions:

Race, and, to a lesser extent, other social factors are correlated with adverse cervical properties. This pathway could explain a proportion of the racial disparity in preterm birth.

Authors+Show Affiliations

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA.Department of Obstetrics & Gynecology, Ochsner Health System , New Orleans , LA , USA.Department of Global Community Health and Behavior, Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA.Department of Biomedical Engineering, Tulane University School of Science and Engineering , New Orleans , LA , USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29852821

Citation

Harville, Emily W., et al. "Cervical Pathways for Racial Disparities in Preterm Births: the Preterm Prediction Study." The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 32, no. 23, 2019, pp. 4022-4028.
Harville EW, Knoepp LR, Wallace ME, et al. Cervical pathways for racial disparities in preterm births: the Preterm Prediction Study. J Matern Fetal Neonatal Med. 2019;32(23):4022-4028.
Harville, E. W., Knoepp, L. R., Wallace, M. E., & Miller, K. S. (2019). Cervical pathways for racial disparities in preterm births: the Preterm Prediction Study. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 32(23), 4022-4028. https://doi.org/10.1080/14767058.2018.1484091
Harville EW, et al. Cervical Pathways for Racial Disparities in Preterm Births: the Preterm Prediction Study. J Matern Fetal Neonatal Med. 2019;32(23):4022-4028. PubMed PMID: 29852821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical pathways for racial disparities in preterm births: the Preterm Prediction Study. AU - Harville,Emily W, AU - Knoepp,Leise R, AU - Wallace,Maeve E, AU - Miller,Kristin S, Y1 - 2018/07/01/ PY - 2018/6/2/pubmed PY - 2020/2/7/medline PY - 2018/6/2/entrez KW - Cervix uteri KW - continental population groups KW - obstetric labor KW - premature KW - premature birth KW - social determinants of health SP - 4022 EP - 4028 JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JO - J Matern Fetal Neonatal Med VL - 32 IS - 23 N2 - Purpose: Racial disparities in preterm birth have been long recognized, but the social and biological mechanisms for these differences are unclear. Our analysis had three goals: (1) to determine the relation between race and other social risk factors and cervical structure; (2) to determine whether social factors mediate the relation between race and cervical structure; and (3) to determine whether racial disparities in preterm birth (PTB) are mediated through changes in cervical structure observed earlier in pregnancy. Materials and methods: Data from the Maternal Fetal Medicine Unit network Preterm Prediction Study were used to examine the relation between race and other social factors and cervical properties throughout pregnancy in 2920 black and white women. Outcomes included cervical length and dilation; cervical score (cervical length-internal dilation); and whether membranes protruded at 22-24 and 26-29 weeks. Race, education, income, insurance type, and marital status were examined as predictors of the outcomes using linear and logistic regression, adjusting for age, BMI, parity, and smoking. Mediation analysis was used to examine whether (a) any social factors explained racial differences in cervical properties, and (b) whether cervical properties mediated racial differences in risk for preterm birth. Results: Shorter cervical length, especially at a subject's first visit, was associated with black race (adjusted beta -1.56 mm, p < .01) and lower income (adjusted beta -1.48, p =.05). External dilation was not associated with social factors, while internal dilation was associated with black race and lower education. Black race and marital status were associated with lower cervical score. There was no evidence of mediation of the racial effect on cervical properties by any social factor. Shorter cervical length, dilation, and score were all associated with preterm birth (p < .01). Mediation analysis indicated that each of these mediated the effect of race, but explained a small proportion of the total effect (15-25%). Conclusions: Race, and, to a lesser extent, other social factors are correlated with adverse cervical properties. This pathway could explain a proportion of the racial disparity in preterm birth. SN - 1476-4954 UR - https://www.unboundmedicine.com/medline/citation/29852821/Cervical_pathways_for_racial_disparities_in_preterm_births:_the_Preterm_Prediction_Study_ L2 - https://www.tandfonline.com/doi/full/10.1080/14767058.2018.1484091 DB - PRIME DP - Unbound Medicine ER -