Social Determinants of Preterm Birth Amongst Non-Hispanic Black Individuals.

Abstract

Background: Non-Hispanic Black pregnancies are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the US.

Objective: Identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black pregnancies.

Study design: Population-based retrospective case-control study of US birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks) and term (≥37 weeks gestation). Logistic regression quantified the association between SDoH and PTB such as maternal age, insurance, education, and prenatal care visits, and reported as odds ratios (95% confidence interval, CI).

Results: Of 2,763,235 live births to Black pregnancies, 340,480 (12%) occurred <37 weeks. Factors most strongly associated with PTB (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 WIC during the pregnancy had a protective effect on PTB risk in Black pregnancies, OR 0.83 (0.83-0.84).

Conclusion: Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, with less than a high school education, unmarried, little to no prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Understanding the lived experience of Black pregnant people and these selected indicators of SDoH that contribute to the risk of PTB may inform development of interventions to address the racial disparity in PTB in the US.