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Adverse Perinatal Outcomes Among Interracial Couples in the United States

From the Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine & Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey; and Department of Epidemiology University of Medicine & Dentistry of New Jersey–School of Public Health, Piscataway, New Jersey.

Objective: We examined the association between parental race and stillbirth and adverse perinatal and infant outcomes.

Methods: We conducted a retrospective cohort analysis using the 1995–2001 linked birth and infant death files that are composed of live births and fetal and infant deaths in the United States. The study included singleton births delivered at 20 or more weeks of gestation with a fetus weighing 500 g or more (N = 21,005,786). Parental race was categorized as mother white–father white, mother white–father black, mother black–father white, and mother black–father black. Multivariable logistic regression analysis was performed to examine the association between parental race and risks of stillbirth (at 20 weeks), small for gestational age (defined as birth weight < 5th and < 10th percentile for gestational age), and early neonatal (< 7 days), late neonatal (7–27 days), and postneonatal (28–364 days) mortality. All analyses were adjusted for the confounding effects of maternal age, education, trimester at which prenatal care began, parity, marital status, and smoking during pregnancy.

Results: Although risks varied across parental race categories, stillbirth was associated with a higher-than-expected risk for interracial couples: mother white–father black, relative risk (RR) 1.17 (95% confidence interval [CI] 1.10–1.26) and mother black–father white, RR 1.37 (95% CI 1.21–1.54) compared with mother white–father white parents. The RR for stillbirth was even higher among mother black–father black parents (RR 1.67, 95% CI 1.62–1.72). The overall patterns of association for small for gestational age births (< 5th and < 10th percentile) and early neonatal mortality were similar to those seen for stillbirth.

Conclusion: There is an increased risk of adverse perinatal outcomes for interracial couples, including stillbirth, small for gestational age infants, and neonatal mortality.

Level of Evidence: II-2

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