Abstract
BackgroundRacial disparities in birth outcomes are mirrored in cardiovascular health. Recently there have been calls for more attention to preconception and interconceptional health in order to improve birth outcomes, including as a strategy to reduce black-white disparities.MethodsAs part of a larger study of cardiovascular and reproductive health (“Bogalusa Babies”), female participants were linked to their children’s birth certificates for Louisiana, Mississippi, and Texas births from 1982 to 2009. Three thousand and ninety-five women were linked to birth certificate data. Birth outcomes were defined as low birthweight (LBW) birthweight < 2500 g; preterm birth (PTB), > 3 weeks early; small for gestational age (SGA), <10th percentile for gestational age (percentiles based on study population); large for gestational age (LGA) >90th percentile for gestational age]. Cardiovascular measures (blood pressure, lipids, glucose, insulin) at the visit closest in time but prior to the pregnancy was examined as predictors of birth outcomes using logistic models adjusted for covariates.ResultsOnly a few cardiovascular risk factors were associated with birth outcomes. Triglycerides were associated with higher risk of LBW among whites (aOR 1.05, 95% 1.01–1.10). Higher glucose was associated with a reduction in risk of SGA for black women (aOR 0.85, 95% CI 0.76–0.95), but not whites (p for interaction = 0.02). Clear racial disparities were found, but they were reduced modestly (LBW/SGA) or not at all (PTB/LGA) after CVD risk factors were adjusted for.ConclusionsThis analysis does not provide evidence for preconception cardiovascular risk being a strong contributor to racial disparities.
Highlights
Racial disparities in birth outcomes are mirrored in cardiovascular health
We examine how pre-pregnancy cardiovascular risk factors are associated with birth outcomes in the Bogalusa Heart Study, a biracial study of cardiovascular health
The research questions are a) are pre-pregnancy cardiovascular risk factors associated with birth outcomes in this cohort; b) do any associations between these risk factors and the outcomes differ between African-American and white women? Based on the results of the analyses of those questions, we examined whether pre-pregnancy cardiovascular health contribute to racial disparities in birth outcomes
Summary
There have been calls for more attention to preconception and interconceptional health in order to improve birth outcomes, including as a strategy to reduce black-white disparities. In the United States, blacks have roughly double the risk of infant mortality of other ethnic groups [1], due largely to preterm birth and fetal growth restriction This disparity persists across populations with comparable access to health care and in otherwise low-risk groups, such as military populations, those with health insurance, and women with higher education and low initial medical risk [2,3,4]. There have been calls for more attention to preconception and interconceptional health in order to improve birth outcomes [8,9,10,11], including as a strategy to reduce black-white disparities [12, 13], in part because black women have an increased risk of preconception hypertension and diabetes [14].
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