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Early Access to Prenatal Care

Implications for Racial Disparity in Perinatal Mortality

From ¹Columbia University, New York, New York; ²DM-STAT, Medford, Massachusetts; ³University of Utah Health Sciences Center, Salt Lake City, Utah; ⁴Swedish Medical Center, Seattle, Washington; ⁵William Beaumont Medical Center, Royal Oak, Texas; ⁶University of Texas Medical Branch, Galveston, Texas; ⁷Mount Sinai Medical Center, New York, New York; ⁸Albert Einstein College of Medicine, Bronx, New York; ⁹University of Colorado Health Sciences Center, Denver, Colorado; ¹⁰Tufts University, Boston, Massachusetts; ¹¹New York University, New York, New York; ¹²Women and Infants’ Hospital, Rhode Island; ¹³and University of North Carolina, Chapel Hill, North Carolina.

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.

LEVEL OF EVIDENCE: II-2

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