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Licensed Unlicensed Requires Authentication Published by De Gruyter December 18, 2020

Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing

  • Khalidha Nasiri EMAIL logo , Erica E. M. Moodie and Haim A. Abenhaim

Abstract

Objectives

We estimated the degree to which the association between race and spontaneous recurrent preterm delivery is mediated by the timing of the first prenatal care visit.

Methods

A retrospective population-based cohort study was conducted using the U.S. National Center for Health Statistics Natality Files. We identified 644,576 women with a prior PTB who delivered singleton live neonates between 2011 and 2017. A mediation analysis was conducted using log-binomial regression to evaluate the mediating effect of timing of first prenatal care visit.

Results

During the seven-year period, 349,293 (54.2%) White non-Hispanic women, 131,296 (20.4%) Black non-Hispanic women, 132,367 (20.5%) Hispanic women, and 31,620 (4.9%) Other women had a prior preterm delivery. The risk of late prenatal care initiation was higher in Black non-Hispanic women, Hispanic women, and Other women (women of other racial/ethnic backgrounds) compared to White non-Hispanic women, and the risk of preterm delivery was higher in women with late prenatal care initiation. Between 8 and 15% of the association between race and spontaneous recurrent preterm delivery acted through the delayed timing of the first prenatal care visit.

Conclusions

Racial disparities in spontaneous recurrent preterm delivery rates can be partly, but not primarily, attributed to timing of first prenatal care visit.


Corresponding author: Khalidha Nasiri, MSc, MD Candidate, Schulich School of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; and Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada, E-mail:

Acknowledgments

Khalidha Nasiri received funding from the Canadian Institutes of Health Research – Frederick Banting and Charles Best Canada Graduate Scholarship in support of her Master’s research. They were not involved in study design, collection, analysis and interpretation of the data, report writing, and in the decision to submit the article for publication.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Khalidha Nasiri received funding from the Canadian Institutes of Health Research – Frederick Banting and Charles Best Canada Graduate Scholarship in support of her Master’s research. They were not involved in study design, collection, analysis and interpretation of the data, report writing, and in the decision to submit the article for publication. All other authors state no conflict of interest.

  4. Ethical approval: The Research Ethics Committee at the authors’ institution considered this study exempt from ethical approval because it is based on publicly available data.

References

1. Liu, L, Johnson, HL, Cousens, S, Perin, J, Scott, S, Lawn, JE, et al.. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379:2151–61. https://doi.org/10.1016/s0140-6736(12)60560-1.Search in Google Scholar

2. Adams, MM, Elam-Evans, LD, Wilson, HG, Gilbertz, DA. Rates of and factors associated with recurrence of preterm delivery. J Am Med Assoc 2000;283:1591–6. https://doi.org/10.1001/jama.283.12.1591.Search in Google Scholar

3. Ananth, CV, Getahun, D, Peltier, MR, Salihu, HM, Vintzileos, AM. Recurrence of spontaneous versus medically indicated preterm birth. Am J Obstet Gynecol 2006;195:643–50. https://doi.org/10.1016/j.ajog.2006.05.022.Search in Google Scholar

4. Goldenberg, RL, Culhane, JF, Iams, JD, Romero, R. Epidemiology and causes of preterm birth. Lancet 2008;37:75–84. https://doi.org/10.1016/s0140-6736(08)60074-4.Search in Google Scholar

5. Goldenberg, RL, Rouse, DJ. Prevention of premature birth. N Engl J Med 1998;339:313–20. https://doi.org/10.1056/nejm199807303390506.Search in Google Scholar

6. Ananth, CV, Joseph, KS, Demissie, K, Vintzileos, AM. Trends in twin preterm birth subtypes in the United States, 1989 through 2000: impact on perinatal mortality. Am J Obstet Gynecol 2005;193:1076e1–e9. https://doi.org/10.1016/j.ajog.2005.06.088.Search in Google Scholar

7. Kistka, ZAF, Palomar, L, Lee, KA, Boslaugh, SE, Wangler, MF, Cole, FS, et al.. Racial disparity in the frequency of recurrence of preterm birth. Am J Obstet Gynecol 2007;196:131.e1–e6. https://doi.org/10.1016/j.ajog.2006.06.093.Search in Google Scholar

8. Turienzo, CF, Sandall, J, Peacock, JL. Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis. BMJ Open 2016;6:e009044.10.1136/bmjopen-2015-009044Search in Google Scholar PubMed PubMed Central

9. Campbell, S. Prevention of spontaneous preterm birth: universal cervical length assessment and vaginal progesterone in women with a short cervix: time for action! Am J Obstet Gynecol 2018;218:151–8. https://doi.org/10.1016/j.ajog.2017.12.222.Search in Google Scholar

10. Committee on Practice Bulletins – Obstetrics, The American College of Obstetricians and Gynecologists. Practice Bulletin No. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;120:964–73. https://doi.org/10.1097/AOG.0b013e3182723b1b.Search in Google Scholar

11. Osterman, MJK, Martin, JA. Timing and adequacy of prenatal care in the United States, 2016. Natl Vital Stat Rep 2018;67:1–14.Search in Google Scholar

12. Krieger, N. Refiguring “race”: epidemiology, racialized biology, and biological expressions of race relations. Int J Health Serv 2000;30:211–6. https://doi.org/10.2190/672j-1ppf-k6qt-9n7u.Search in Google Scholar

13. Thoma, ME, De Silva, DA, MacDorman, MF. Examining interpregnancy intervals and maternal and perinatal health outcomes using U.S. vital records: important considers for analysis and interpretation. Paediatr Perinat Epidemiol 2018;33:O60–72. https://doi.org/10.1111/ppe.12520.Search in Google Scholar

14. Blencowe, H, Cousens, S, Oestergaard, MZ, Chou, D, Moller, AB, Narwal, R, et al.. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162–72. https://doi.org/10.1016/s0140-6736(12)60820-4.Search in Google Scholar

15. Martin, JA, Osterman, MJK, Kirmeyer, SE, Gregory, EC. Measuring gestational age in vital statistics data: transitioning to the obstetric estimate. Natl Vital Stat Rep 2015;64:1–20.Search in Google Scholar

16. VanderWeele, TJ. Explanation in causal inference: methods for mediation and interaction. Oxford, UK: Oxford University Press; 2015.10.1093/ije/dyw277Search in Google Scholar

17. Greenland, S. Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol 2004;160:301–5. https://doi.org/10.1093/aje/kwh221.Search in Google Scholar

18. Sobel, ME. Asymptotic confidence intervals for indirect effects in structural equation models. Soc Methodol 1982;13:290–312. https://doi.org/10.2307/270723.Search in Google Scholar

19. Lu, MC, Chen, B. Racial and ethnic disparities in preterm birth: the role of stressful life events. Am J Obstet Gynecol 2004;191:691–9. https://doi.org/10.1016/j.ajog.2004.04.018.Search in Google Scholar

20. Sparks, PJ. Do biological, sociodemographic, and behavioral characteristics explain racial/ethnic disparities in preterm births. Soc Sci Med 2009;69:1667–75. https://doi.org/10.1016/j.socscimed.2009.02.026.Search in Google Scholar

21. Mercer, BM, Goldenberg, RL, Moawad, AH, Meis, PJ, Iams, JD, Das, AF, et al.. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol 1999;181:1216–21. https://doi.org/10.1016/s0002-9378(99)70111-0.Search in Google Scholar

22. Partridge, S, Balayla, J, Holcroft, CA, Abenhaim, HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol 2012;29:787–94. https://doi.org/10.1055/s-0032-1316439.Search in Google Scholar

23. Adams, MM, Elam-Evans, LD, Wilson, HG, Gilbertz, DA. Rates of and factors associated with recurrence of preterm delivery. J Am Med Assoc 2000;283:1591–6. https://doi.org/10.1001/jama.283.12.1591.Search in Google Scholar

24. Yang, J, Baer, RK, Berghella, V, Chambers, C, Chung, P, Coker, T, et al.. Recurrence of preterm birth and early term birth. Obstet Gynecol 2016;128:364–72. https://doi.org/10.1097/aog.0000000000001506.Search in Google Scholar

25. Yee, LM, Liu, LY, Sakowicz, A, Bolden, JR, Miller, ES. Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth. Am J Obstet Gynecol 2016;214:374.e1–e6. https://doi.org/10.1016/j.ajog.2015.12.054.Search in Google Scholar

26. DeNoble, AE, Wynn, CE, Weaver, KE, Wheeler, SM, Swamy, GK. Factors associated with utilization of 17-hydroxyprogesterone caproate for the prevention of recurrent preterm birth. Am J Perinatol 2019;37:264–70. https://doi.org/10.1055/s-0039-1678532.Search in Google Scholar

27. Attanasio, L, Kozhimannil, KB. Patient-reported communication quality and perceived discrimination in maternity care. Med Care 2015;53:863–71. https://doi.org/10.1097/mlr.0000000000000411.Search in Google Scholar

28. Beckmann, CA, Buford, TA, Witt, JB. Perceived barriers to prenatal care services. MCN Am J Matern Child Nurs 2000;25:43–6. https://doi.org/10.1097/00005721-200001000-00009.Search in Google Scholar

29. Close, FT, Suther, S, Foster, A, Battle, AM. Community perceptions of black infant mortality: a qualitative inquiry. J Health Care Poor Underserved 2013;24:1089–101. https://doi.org/10.1353/hpu.2013.0118.Search in Google Scholar

30. Coley, SL, Zapata, JY, Schwei, RJ, Mihalovic, GE, Matabele, MN, Jacobs, EA, et al.. More than a “number”: perspectives of prenatal care quality from mothers of color and providers. Women Health Issues 2018;28:158–64. https://doi.org/10.1016/j.whi.2017.10.014.Search in Google Scholar

31. Moore, ML, Meis, PJ, Ernest, JM, Zaccaro, DK, Terrell, T. A randomized trial of nurse intervention to reduce preterm and low birth weight births. Obstet Gynecol 1998;91:656–61. https://doi.org/10.1097/00006250-199805000-00003.Search in Google Scholar

32. Issel, LM, Forrestal, SG, Slaughter, J, Wiencrot, A, Handler, A. A review of prenatal home-visiting effectiveness for improving birth outcomes. J Obstet Gynecol Neonatal Nurs 2011;40:157–65. https://doi.org/10.1111/j.1552-6909.2011.01219.x.Search in Google Scholar

33. Lutenbacher, M, Elkins, T, Dietrich, MS, Riggs, A. The efficacy of using peer mentors to improve maternal and infant health outcomes in Hispanic families: findings from a randomized clinical trial. Matern Child Health J 2018;22:92–104. https://doi.org/10.1007/s10995-018-2532-z.Search in Google Scholar

34. Hadley, J. Sicker and poorer – the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev 2003;60:3S–75S. https://doi.org/10.1177/1077558703254101.Search in Google Scholar

35. Newman, RB, Sullivan, SA, Menard, MK, Rittenberg, CS, Rowland, AK, Korte, JE, et al.. South Carolina Partners for Preterm Birth Prevention: a regional perinatal initiative for the reduction of premature birth in a Medicaid population. Am J Obstet Gynecol 2008;199:393.e1–e8. https://doi.org/10.1016/j.ajog.2008.07.047.Search in Google Scholar

36. Yoder, H, Hardy, LR. Midwifery and antenatal care for black women: a narrative review. SAGE Open 2018;8:1–8. https://doi.org/10.1177/2158244017752220.Search in Google Scholar

37. Hafeman, DM, Schwartz, S. Opening the black box: a motivation for the assessment of mediation. Int J Epidemiol 2009;38:838–45. https://doi.org/10.1093/ije/dyn372.Search in Google Scholar

38. Richiardi, L, Bellocco, R, Zugna, D. Mediation analysis in epidemiology: methods, interpretation and bias. Int J Epidemiol 2013;42:1511–9. https://doi.org/10.1093/ije/dyt127.Search in Google Scholar

39. Heaman, MI, Newburn-Cook, CV, Green, CG, Elliot, LJ, Helewa, ME. Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices. BMC Pregnan Childbirth 2008;8:15. https://doi.org/10.1186/1471-2393-8-15.Search in Google Scholar


Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0133).


Received: 2020-03-26
Accepted: 2020-12-02
Published Online: 2020-12-18
Published in Print: 2021-05-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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