Increased Risk of Preterm Birth in a Native American Population Concurrent With the COVID-19 Pandemic [ID: 1377321

Abstract

INTRODUCTION: The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups. METHODS: An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes. RESULTS: Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI >30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation. CONCLUSION: There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.