Higher risk of preterm birth in U.S. black women may have more to do with racial bias than socioeconomic status

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By Rob Goodier

NEW YORK (Reuters Health) - Black women in the United States have long been known to have a higher rate of preterm birth than white women, and new research suggests racial bias may be at the heart of the problem.

A study of data from more than 2 million women of high socioeconomic status found preterm birthrates of up to six times higher among black women than white women, according to research presented February 7 at the annual meeting of the Society of Maternal-Fetal Medicine in Grapevine, Texas.

"I think sometimes medical providers think that if women are able to do things like have private insurance and get to prenatal visits, that will fix the problem of health disparities, but unfortunately, this problem is not about our patients," the study's lead author, Dr. Jasmine Johnson of the University of North Carolina at Chapel Hill, told Reuters Health by email.

Dr. Johnson and colleagues analyzed live-birth records from the U.S. National Vital Statistics System over a two-year period, limiting their study to non-Hispanic white, black and mixed race (white and black) women with 16 or more years of education, private insurance and who were not receiving Women, Infants and Children (WIC) benefits.

The study divided the women into three groups according to the gestational age of their newborns: less than 37 weeks, less than 34 weeks and less than 28 weeks.

Unadjusted data suggested that at less than 37 weeks, preterm-birth rates were 5.5% of white women, 6.1% of mixed-race women and 9.9% of black women (P<0.001). At less than 34 weeks, rates were 1.1% of white women, 1.5% of mixed-race and 3.5% of black women (P<0.001). At less than 28 weeks, rates were 0.2% of white women, 0.4% of mixed race and 1.2% of black women (P<0.001).

The differences remained significant in logistic regression adjusting for marital status, history of preterm birth, smoking, male fetus, and chronic hypertension.

The research underscores the issue of racial inequities in the healthcare system and other institutions, said Dr. Conisha Holloman, a maternal-fetal-medicine fellow at the Texas Health Science Center in Houston, who was not involved in the study.

"More attention needs to be placed on the inherent biases that we hold as a healthcare profession toward people of color," Dr. Holloman told Reuters Health by phone. Part of that effort should include more investigation into biases and training of practitioners to recognize their biases and avoid acting on them.

The findings reflect similar results in regional research, and they come as no surprise, Dr. Johnson said.

"In this study, as in others in medicine, race is a social construct - a surrogate for structural and societal racism that disproportionately affects the birth outcomes of women of color," she said. "Focused efforts should continue to evaluate how factors such as life experiences including racism, resilience, and allostatic load or weathering, in combination with traditional prematurity risk factors, influence an individual's risk of preterm birth."

SOURCE: https://bit.ly/39A7Kkj presented February 7 at SMFM's 40th Annual Pregnancy Meeting.

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