- •Early and adequate prenatal care reduces preterm birth rates for low-income women.
- •In Sacramento County, low-income Black women use prenatal care more than White women.
- •Low-income Black women still have higher rates of preterm birth.
- •Access to prenatal care is insufficient to reduce preterm birth racial disparities.
- •Comprehensive, multidimensional health interventions may improve racial equity.
To examine the effectiveness of early and adequate prenatal care (PNC) in reducing racial disparities in pre-term birth (PTB) among low-income women.
Design and methods
This retrospective study examined birth records for 14,950 low-income Black and White women. The primary outcome of interest was racial disparities in PTB. Exposures of interest were first trimester entry into, and adequacy of, PNC. Maternal residential proximity to nearest PNC provider was calculated. Bivariate analyses were performed for PTB by race. Binary logistic regression was performed, controlling for maternal age, smoking status and racial segregation. Attributable risk of PTB for no or late entry into PNC, and percent difference by race was calculated.
We find that early and adequate PNC significantly decreases the risk of preterm birth, however, we find no evidence that this reduces racial disparities. Low income black females in a large metropolitan county have greater geographic access to and utilization of PNC than low-income white females, yet racial disparities in preterm birth remain. Attributable risk of PTB for no or late entry into PNC was lower for Black women (32.2%) than White women (39.4%).
Our findings suggest that adequate PNC alone does not reduce the marked racial disparities in preterm birth.
Public health agencies and health care providers need to look beyond access to care, to achieve racial equity in birth outcomes. Expansion of evidence-based, comprehensive nursing interventions shown to reduce preterm birth, such as the Nurse Family Partnership home visiting program, could contribute to these efforts.
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- Maternal, infant and child health.in: Healthy people 2020. U.S. Department of Health and Human Services, 2018https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives
- 2019 March of Dimes report card.March of Dimes, 2019
- Prenatal care.National Institutes of Health, 2020 (Retrieved from)
- The statistical analysis of compositional data.Journal of the Royal Statistical Society. Series B (Methodological). 1982; : 139-177
- Compositional data analysis: Where are we and where should we be heading?.Mathematical Geology. 2005; 37: 829-850
- Unequal gain of equal resources across racial groups.International Journal of Health Policy and Management. 2018; 7: 1-9
- Patient-reported communication quality and perceived discrimination in maternity care.Medical Care. 2015; 53: 863
- Birth outcomes among urban African-American women: A multilevel analysis of the role of racial residential segregation.Social Science & Medicine. 2006; 63: 3030-3045
- Positional accuracy of geocoded addresses in epidemiologic research.Epidemiology. 2003; 14: 408-412
- Preterm birth.https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htmDate: 2019, October 21
- Using Index of Concentration at the Extremes as indicators of structural racism to evaluate the association with preterm birth and infant mortality - California, 2011–2012.Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2019; 96: 159-170
- More than a “number”: Perspectives of prenatal care quality from mothers of color and providers.Women’s Health Issues: Official publication of the Jacobs Institute of Women’s Health. 2018; 28: 158-164
- Racial residential segregation and low birth weight in Michigan’s metropolitan areas.American Journal of Public Health. 2011; 101: 1714-1720
- Effects of maternal age and age-specific preterm birth rates on overall preterm birth rates - United States, 2007 and 2014.Morbidity and Mortality Weekly Report. 2016; 65 (Centers for Disease Control and Prevention)
- “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States.American Journal of Public Health. 2006; 96: 826-833
- Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices.BMC Pregnancy and Childbirth. 2008; 8: 15
- Evaluation of California’s statewide implementation of enhanced perinatal services as Medicaid benefits.Public Health Reports (Washington, D.C.:1974). 1995; 110: 125-133
- The adequacy of prenatal care utilization index: Its US distribution and association with low birthweight.American Journal of Public Health. 1994; 84: 1486-1489
- The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community.SSM-Population Health. 2016; 2: 859-867
- Do measures matter? Comparing surface-density-derived and census-tract-derived measures of racial residential segregation.International Journal of Health Geographics. 2010; 9: 29
- Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology.American Journal of Public Health. 1992; 82: 703-710
- Weight gain during pregnancy and the black-white disparity in preterm birth.Annals of Epidemiology. 2017; 27 (e1): 323-328
- Trends in smoking and smoking cessation during pregnancy from 1985 to 2014, racial and ethnic disparity observed from multiple national surveys.Maternal and Child Health Journal. 2018; 22: 685-693
- Racial and ethnic disparities in birth outcomes: A life-course perspective.Maternal and Child Health Journal. 2003; 7: 13-30
- Closing the black-white gap in birth outcomes: A life-course approach.Ethnicity & Disease. 2010; 20 (S2. (PMC4443479)): 62-76
- Defining the problem: The epidemiology of preterm birth.BJOG: An International Journal of Obstetrics & Gynaecology. 2003; 110: 3-7
- Births: Final data for 2018.in: National vital statistics reports. 68(13). National Center for Health Statistics, 2019
- Segregation and preterm birth: The effects of neighborhood racial composition in North Carolina.Health & Place. 2009; 15: 1-9
- Stress, adaptation, and disease: Allostasis and allostatic load.Annals of the New York Academy of Sciences. 1998; 840: 33-44
- Prenatal and infancy nurse home visiting effects on mothers: 18-year follow-up of a randomized trial.Pediatrics. 2019; 144
- Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial.Pediatrics. 2007; 120: E832-E845
- Compositional data and their analysis: An introduction.Geological Society, London, Special Publications. 2006; 264: 1-10
- Long-term healthcare outcomes of preterm birth: An executive summary of a conference sponsored by the National Institutes of Health.The Journal of Pediatrics. 2017; 181 (e1): 309-318
- Use and misuse of population attributable fractions.American Journal of Public Health. 1998; 88: 15-19
- Access to comprehensive perinatal services among pregnant women enrolled in both Medi-Cal and Covered California: Aligning and integrating care.Milken Institute School of Public Health, The George Washington University, 2014
- Department of Health Services.Comprenhensive Perinatal Services 2021 Program, 2021https://dhs.saccounty.net/PUB/Pages/Comprehensive-Perinatal-Services-Program/SP-Comprehensive-Perinatal-Services-Program-(CPSP).aspx
- Causes of death in very preterm infants cared for in neonatal intensive care units: A population-based retrospective cohort study.BMC Pediatrics. 2017; 17: 59
- CDC Grand Rounds: Public health strategies to prevent preterm birth.Morbidity and Mortality Weekly Report. 2016; 65 (Centers for Disease Control and Prevention)
- Fighting at birth: Eradicating the Black-White infant mortality gap.Duke University’s Samuel DuBois Cook Center on Social Equity, and Insight Center for Community Economic Development, 2018https://socialequity.duke.edu/wp-content/uploads/2019/12/Eradicating-Black-Infant-Mortality-March-2018.pdf
- Status of birth outcomes in clients of the nurse-family partnership.Maternal Child Health Journal. 2017; 21: 995-1001
- Preconception biomarkers of allostatic load and racial disparities in adverse birth outcomes: The Bogalusa Heart Study.Paediatric and Perinatal Epidemiology. 2013; 27: 587-597
- How and why do interventions that increase health overall widen inequalities within populations.Social Inequality and Public Health. 2009; 65: 82
- Racism and health: Evidence and needed research.Annual Review of Public Health. 2019; 40: 105-125
Published online: February 12, 2021
Accepted: January 14, 2021
Received in revised form: January 11, 2021
Received: October 5, 2020
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