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Am J Perinatol 2025; 42(06): 781-787
DOI: 10.1055/a-2419-9229
Original Article

Social Determinants of Preterm Birth amongst Non-Hispanic Black Individuals

Diane N. Fru
1   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Elizabeth Kelly
1   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
2   Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
Matthew Orischak
1   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Emily A. DeFranco 
3   Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky
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Funding None.
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Abstract

Objective

Non-Hispanic Black individuals are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the United States. The objective of this study is to identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black individuals.

Study Design

Population-based retrospective case–control study of U.S. 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 of gestation) and term (≥37 weeks of gestation). Logistic regression quantified the association between SDoH and PTB such as insurance, education, and prenatal care visits and reported as odds ratios (ORs; 95% confidence interval, CI).

Results

Of 2,763,235 live births to Black individuals, 340,480 (12%) occurred <37 weeks of gestation. Factors most strongly associated with PTB (p < 0.001), presented as OR (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), 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). Receipt of WIC (women, infants, and children) during the pregnancy had a protective effect on PTB risk in Black individuals, OR = 0.83 (0.83–0.84).

Conclusion

Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, have less than a high school education, are unmarried, have 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 United States.

Key Points

  • Preterm birth disproportionately affects Black individuals.

  • SDoH are contributors to preterm birth.

  • This study investigates social determinant influences on preterm birth among Black individuals.

Keywords

perinatal mortality - preterm birth - social determinants of health - WHO - WIC

Note

This study was presented as a poster at the Society of Maternal-Fetal Medicine's 42nd Annual Pregnancy Meeting January 31–February 5, 2022, Orlando, FL.




Publikationsverlauf

Eingereicht: 26. März 2024

Angenommen: 20. September 2024

Accepted Manuscript online:
24. September 2024

Artikel online veröffentlicht:
16. Oktober 2024

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