Abstract

Efforts to recognize risk factors for preterm birth (PTB) are essential as this is a leading cause of perinatal mortality in the US. This study aims to identify risk factors that may be drivers of higher preterm birth rates amongst non-Hispanic black women. Population-based retrospective case-control study of the US birth records (2012—2016). Factors potentially associated with preterm birth and considered as indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women delivering preterm (< 37 weeks gestation) and term (≥ 37 weeks gestation). Multivariate logistic regression quantified the association between social determinants and PTB such as maternal age, insurance type, education level, and amount of prenatal care, and reported as odds ratios (95% confidence interval, CI). Of 2,763,235 live births to Black women in the US during the study period, 340,480 (12% of births to Black women) occurred < 37 weeks. Factors most strongly associated with preterm birth (P< .001), presented as odds ratio (95% CI) included no prenatal care 3.0 (95% CI, 2.9—3.1) or insufficient prenatal care 2.7 (95% CI, 2.7—2.8); smoking during pregnancy 1.4 (95% CI, 1.43—1.47), age ≥ 35 years 1.3 (95% CI, 1.3—1.35), unmarried 1.18 (95% CI, 1.17—1.19), lack of high school diploma 1.1 (95% CI, 1.12—1.40), lack of father of baby listed on birth certificate 1.22 (1.21—1.23), and Black paternal race 1.10 (1.08—1.12). Utilization of government-funded resources of Medicaid and WIC had opposite influence on PTB risk in Black women, OR 1.08 (1.07—1.09) and 0.83 (0.83—0.84), respectively. Non-Hispanic Black women with older age, smokers, Medicaid insurance, lower education, unmarried, lack of prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Addressing these indicators of SDH that contribute to the risk of PTB, specifically amongst Black women, may help to address the racial disparity in adverse perinatal outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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