Early access to prenatal care

Implications for racial disparity in perinatal mortality

Andrew J. Healy, Fergal D. Malone, Lisa M. Sullivan, T. Flint Porter, David A. Luthy, Christine H. Comstock, George Saade, Richard Berkowitz, Susan Klugman, Lorraine Dugoff, Sabrina D. Craigo, Ilan Timor-Tritsch, Stephen R. Carr, Honor M. Wolfe, Diana W. Bianchi, Mary E. D'Alton

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care.

Original languageEnglish (US)
Pages (from-to)625-631
Number of pages7
JournalObstetrics and Gynecology
Volume107
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

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Prenatal Care
Perinatal Mortality
Pregnancy
Fetal Death
Uterine Hemorrhage
Premature Birth
Hispanic Americans
Population
Obstetrics
Placenta Previa
Gestational Diabetes
Pre-Eclampsia
Odds Ratio
Databases
Confidence Intervals
Growth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Healy, A. J., Malone, F. D., Sullivan, L. M., Porter, T. F., Luthy, D. A., Comstock, C. H., ... D'Alton, M. E. (2006). Early access to prenatal care: Implications for racial disparity in perinatal mortality. Obstetrics and Gynecology, 107(3), 625-631. https://doi.org/10.1097/01.AOG.0000201978.83607.96

Early access to prenatal care : Implications for racial disparity in perinatal mortality. / Healy, Andrew J.; Malone, Fergal D.; Sullivan, Lisa M.; Porter, T. Flint; Luthy, David A.; Comstock, Christine H.; Saade, George; Berkowitz, Richard; Klugman, Susan; Dugoff, Lorraine; Craigo, Sabrina D.; Timor-Tritsch, Ilan; Carr, Stephen R.; Wolfe, Honor M.; Bianchi, Diana W.; D'Alton, Mary E.

In: Obstetrics and Gynecology, Vol. 107, No. 3, 03.2006, p. 625-631.

Research output: Contribution to journalArticle

Healy, AJ, Malone, FD, Sullivan, LM, Porter, TF, Luthy, DA, Comstock, CH, Saade, G, Berkowitz, R, Klugman, S, Dugoff, L, Craigo, SD, Timor-Tritsch, I, Carr, SR, Wolfe, HM, Bianchi, DW & D'Alton, ME 2006, 'Early access to prenatal care: Implications for racial disparity in perinatal mortality', Obstetrics and Gynecology, vol. 107, no. 3, pp. 625-631. https://doi.org/10.1097/01.AOG.0000201978.83607.96
Healy, Andrew J. ; Malone, Fergal D. ; Sullivan, Lisa M. ; Porter, T. Flint ; Luthy, David A. ; Comstock, Christine H. ; Saade, George ; Berkowitz, Richard ; Klugman, Susan ; Dugoff, Lorraine ; Craigo, Sabrina D. ; Timor-Tritsch, Ilan ; Carr, Stephen R. ; Wolfe, Honor M. ; Bianchi, Diana W. ; D'Alton, Mary E. / Early access to prenatal care : Implications for racial disparity in perinatal mortality. In: Obstetrics and Gynecology. 2006 ; Vol. 107, No. 3. pp. 625-631.
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AU - Healy, Andrew J.

AU - Malone, Fergal D.

AU - Sullivan, Lisa M.

AU - Porter, T. Flint

AU - Luthy, David A.

AU - Comstock, Christine H.

AU - Saade, George

AU - Berkowitz, Richard

AU - Klugman, Susan

AU - Dugoff, Lorraine

AU - Craigo, Sabrina D.

AU - Timor-Tritsch, Ilan

AU - Carr, Stephen R.

AU - Wolfe, Honor M.

AU - Bianchi, Diana W.

AU - D'Alton, Mary E.

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N2 - OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care.

AB - OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care.

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