405: Racial disparity in rate of rise of no prenatal care in the US

Abstract

There is an increasing number of women who receive no prenatal care (PNC) during pregnancy in the US in recent years. We aim to assess whether racial differences in care explain some of this rise. Population-based retrospective cohort study of all US live births between 20-42 weeks gestation using vital statistics birth records. Live births to mothers who received no PNC were identified as documented on the US certificate of live birth. Rates of no PNC were calculated for each year of the study period (2012-2016) and compared between mothers of non-Hispanic (NH) white and NH black race. Multivariate logistic regression estimated the relative risk of race on no PNC with adjustment for coexisting risk factors. There were 19,547,691 live births analyzed. The rate of no PNC during the study period was 1.47%, and increased from 1.36% in 2012 to 1.58% in 2016, p< 0.001. The rate of no PNC doubled in white women from 0.82% to 1.61% during the study period, p< 0.001, while the rate decreased slightly in black women (2.6% to 2.12%), p< 0.001. However, NH black women had a two-fold increased risk of having no PNC compared to NH white women overall (2.27% vs 0.88%), adjRR 2.07 (95% CI 2.04-2.10), even after adjustment for confounding risks. The racial disparity in no PNC decreased over the study period adjRR 2.49, (CI 2.43-2.56) in 2012 vs adjRR 1.27 (CI 1.19-1.34) in 2016, but this was attributed mostly to an increase in no PNC in NH white rather than the decrease in no PNC in black women. We identified a racial disparity in the rate of no prenatal care in the US in recent years, with a nearly 2-fold increased risk in NH black women compared to white, even after adjustment for coexisting risks. However, the frequency of no PNC among NH black women decreased slightly over the study period, but doubled in NH white women. Public health initiative should focus on educating reproductive age women on the importance of prenatal care and improving access to care in effort to reduce the racial disparity in adverse birth outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)