Amer J Perinatol 2017; 34(11): 1065-1071
DOI: 10.1055/s-0037-1603764
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Racial Disparities in Delivery Gestational Age among Twin Pregnancies

Jacqueline H. Grant
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Catherine J. Vladutiu
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Tracy A. Manuck
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

02 May 2017

05 May 2017

Publication Date:
07 June 2017 (eFirst)

Abstract

Objective This study aims to estimate the association between maternal race and delivery gestational age among women with twin gestations.

Study Design Secondary analysis of a prospective, randomized control trial of 17-α hydroxyprogesterone caproate versus placebo for preterm birth (PTB) prevention in twin gestations. Non-Hispanic (NH) black and whites were included. Demographic and antenatal characteristics were compared. The primary outcome was delivery gestational age. Secondary outcomes included a composite of major neonatal morbidity. Kaplan–Meier curves estimated survival probabilities for delivery gestational age by race. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI).

Results A total of 535 women with twin gestations were included; 150 were NH black. NH blacks delivered earlier than NH whites (33.6 ± 4.8 weeks vs. 35.1 ± 3.5 weeks, p < 0.001). Differences in delivery gestational age between NH blacks and whites were consistent across gestation. In adjusted analyses, NH black race (HR: 1.24, 95% CI: 1.02–1.51), prior PTB (HR: 1.59, 95% CI: 1.15–2.19), and cerclage (HR: 3.90, 95% CI: 2.00–7.60) were associated with an increased risk of earlier delivery. Major neonatal morbidity was higher for NH blacks compared with NH whites (12.7 vs. 7.0%, p = 0.036).

Conclusion NH blacks with twin gestations have an increased risk of early delivery and neonatal morbidity compared with NH whites.

Condensation

Non-Hispanic black women with twin gestations deliver earlier than non-Hispanic white women.


Note

This article was presented as a poster at the 2017 Annual Meeting of the Society for Maternal-Fetal Medicine; January 26, 2017; Las Vegas, NV. Final abstract ID# 149.