Preterm Births higher among poor minority women

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A retrospective study of economy and population

Mason, Kaufman, Emch, Hogan, and Savitz1 used birth records for seven ethnic groups in New York City from between 1995 and 2003 to conduct a retrospective study using a cross-sectional research design to investigate the risks for preterm births in African Caribbean and U.S.-born non-Hispanic black populations. The authors found increased numbers of preterm births in African and African American women from deprived neighborhoods. The risk difference for African women was 6.1 per 1,000 (95% CI: 1.9, 10.2), while the risk difference for African American women was 12.5 per 1,000 (95% CI: 6.6, 18.4). The results from this study showed that the health of Black women in majority-black neighborhoods is poorer than other women in mixed neighborhoods. The health of non-Hispanic black immigrant women living in New York was better than the other groups of women. The authors described that differences in study findings may be attributed to social support and the practice of cultural norms among immigrants.

Janviec et al.2 used hospital discharge and birth data for 517,994 singleton live births in New York City between 1998 and 2002 to conduct a retrospective study using a cross-sectional research design to investigate neighborhood deprivation associated with adverse birth outcomes among diverse ethnic groups. Data were gathered from these hospital records. The adjusted odds ratio (aOR) for preterm births less than 32 weeks for the highest quartile of deprivation compared to the lowest was 1.24 (95% confidence limit (CL) = 1.13, 1.36). The aOR for preterm births 33-36 weeks was 1.06 (95% CL=1.01, 1.11). The aOR for term low birth weight 37 week or greater and less than 2500 grams was 1.19 (95% CL= 1.11, 1.27). Results of the study showed that living in a deprived neighborhood was associated with increased numbers of preterm births. Hispanic Caribbean women who lived in deprived neighborhoods had higher rates of preterm births and African women had higher rates of low birth with term infants if lived in a deprived neighborhood. Black migrant women tended to have fewer preterm births than U.S.-born black women and women of other races.

Savard, Levallois, Rivest, and Gingras3 conducted a retrospective study using a cross-sectional design to describe whether social environment was associated with fetal growth retardation. All newborns (667,254) from 143 NICU settings in Canada during 2000-2008 were included in the study. Data were gathered from newborn records in this chosen NICU. Three categories of infants were identified: namely, small for gestational age (SGA), very small for gestational age (VSGA), and small for gestational age premature (SGA-preterm infant). Multivariate analysis revealed that 8.22% of births were SGA and 3.77% were VSGA. Hospitals within Canada that reported more cases of maternal deprivation and sleep deprivation have a higher adjusted risk of SGA births.

Olusanya and Ofovwe4 conducted a retrospective study with a cross-sectional design to determine the prevalence of and risk factors for preterm births and low birth weight in an urban setting in Nigeria. All live births from May 2005 through December 2007 in an inner-city maternity hospital in Lagos, Nigeria, were included in study. Population attributable risk (PAR %) for each factor was determined. Among the 4,314 newborns enrolled, 859 (19.9%) were preterm and 440 (10.2%) were low birth weight. One-third of mothers received no prenatal care, while about 6% had HIV and another 6% had a history of hypertensive disorders. About 43% of infants with a low birth weight were born full-term. Maternal predictors of preterm delivery and/or low birth weight were marital status, occupation, residential accommodation with shared sanitation facilities, lack of prenatal care, and absence of cesarean section, hypertensive disorders, and antepartum hemorrhage. Genetic and intrauterine growth retardation (IUGR) was also predictive of low birth weight. IUGR (PAR = 48.74%) and lack of cesarean section (PAR = 41.99%) were the leading contributors to preterm birth and/or low birth weight. Factors predictive of preterm births and low birth weight were determined using unconditional variable logistic regression.

The commonality among these studies suggests that premature birth rates are related to race and poverty. Black and Hispanic women have higher rates of premature birth than white women. Inadequate income denies a woman the means of affording herself a proper education, and job to afford a healthy lifestyle. Evidence supports that social support and financial security may decrease premature birth rates.5 Nurse Practitioners play an important role in decreasing premature birth rates. They can advocate for more resources for these poor minority women. Nurse Practitioners can work in poor underserved communities where these women live and provide primary, secondary and tertiary level prevention interventions which include providing prenatal education and providing necessary prenatal care throughout the entire pregnancy to reduce the risk of premature birth.

References

  1. Mason, S.M., Kaufman, J.S., Emch, M.E., Hogan, V.K. & Savitz, D.A. Ethnic density and preterm birth in african-caribbean, and non-hispanic black populations in New York City, American Journal of Epidemiology. 2010, 172 (7), 800-808.
  2. Janveic, T., Stein, C.R., Savitz, D.A., Kaufman, J.S., Mason, S.M. & Herring, A.H. Neighborhood deprivation and adverse outcomes among diverse ethnic groups. Annals of Epidemiology. 2010, 20(6), 445-451.
  3. Savard, N., Levallois, P., Rivest, L., & Gingras, S. A study of the association between
    characteristics of CLSCs and risk for small gestational age births among term and preterm births in Quebec, Canada. Canadian Journal of Public Health. 2012, 103(2), 152-57.
  4. Olusanya, B.O., & Ofovwe, G.E. Predictors of preterm births and low birthweight in an inner-city hospital in sub-saharan africa. Journal of Maternal Child Health. 2010, 14, 978-986.
  5. Ghosh, J.C., Wilhelm, M.H., Lombardi, C.A, Dunkel-Schetter, C. & Ritz, B.R. Paternal support and preterm birth, and the moderation of effects of chronic stress: A study in los angeles county mothers. Archives of Women’s Mental Health. 2010, 13(4), 327-38
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About Author

Dr. Jemimah Mitchell-Levy, PhD, ARNP

Dr. Jemimah Mitchell-Levy, PhD, ARNP is a Senior Associate Professor at the Benjamin Leon School of Nursing, Miami Dade College.

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