ReviewObstetricsRacial/ethnic disparities in obstetric outcomes and care: prevalence and determinants
Section snippets
Congenital abnormalities
the most consistent racial/ethnic difference in prevalence of congenital abnormalities appears to be a higher incidence of neural tube defects (NTDs), including spina bifida and anencephaly, among Hispanic women.10, 11, 12, 13 Williams et al14 calculated a recent birth prevalence of spina bifida of 4.18 per 10,000 births among Hispanic women, as compared with 3.37 and 2.90 per 10,000 for non-Hispanic white and black women, respectively, similar to the findings of other studies.
In contrast, the
Disparities in obstetric care
Few agreed-on measures of quality of obstetric care currently exist for evaluation of disparities in care quality.131 The Agency for Healthcare Research and Quality's National Healthcare Disparities Report uses a set of measures to describe quality of care across a variety of settings. Whereas other areas in medicine have numerous available measures, the single measure that reflects quality of obstetric care in this report is the proportion of women who receive prenatal care in the first
Conclusions
As in other fields of medicine, obstetric outcomes differ by maternal race/ethnicity. These disparities ultimately contribute to disparate rates of infant and maternal mortality and thereby reflect the overall health status of the communities in which women and their families live. Whereas some disparities may have their origins in biology and therefore may not be modifiable in the short term, a great many more may be rooted in maternal health behaviors and the physical and social environments,
References (151)
- et al.
The increasing racial disparity in infant mortality rates: composition and contributors to recent US trends
Am J Obstet Gynecol
(2008) - et al.
Race-ethnicity differences in folic acid intake in women of childbearing age in the United States after folic acid fortification: findings from the National Health and Nutrition Examination Survey, 2001-2002
Am J Clin Nutr
(2007) - et al.
Investigation of folate pathway gene polymorphisms and the incidence of neural tube defects in a Texas Hispanic population
Mol Genet Metab
(2000) - et al.
Racial-ethnic differences in prenatal diagnostic test use and outcomes: preferences, socioeconomics, or patient knowledge?
Obstet Gynecol
(1996) Do biological, sociodemographic, and behavioral characteristics explain racial/ethnic disparities in preterm births?
Soc Sci Med
(2009)- et al.
A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth
Am J Obstet Gynecol
(2004) - et al.
Pregnancy outcomes in foreign-born and US-born women
Int J Gynaecol Obstet
(2003) - et al.
Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation
Soc Sci Med
(2006) - et al.
Socioeconomic domains and associations with preterm birth
Soc Sci Med
(2008) - et al.
Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population
Soc Sci Med
(2007)
Race and ethnic differences in determinants of preterm birth in the USA: broadening the social context
Soc Sci Med
Racial and ethnic disparities in preterm birth: the role of stressful life events
Am J Obstet Gynecol
The relationship between racial identity, income, stress and C-reactive protein among parous women: implications for preterm birth disparity research
J Natl Med Assoc
Stress-associated preterm delivery: the role of corticotropin-releasing hormone
Am J Obstet Gynecol
The effects of racial density and income incongruity on pregnancy outcomes
Soc Sci Med
Birth-weight-for-gestational-age patterns by race, sex, and parity in the United States population
Obstet Gynecol
Trends in fetal growth among singleton gestations in the United States and Canada, 1985 through 1998
Semin Perinatol
Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women
J Nutr
National healthcare disparities report
confronting racial and ethnic disparities in health care
Healthy people 2010
final data for 2006
Natl Vital Stat Rep
Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates
Paediatr Perinat Epidemiol
Measuring trends in racial/ ethnic health care disparities
Med Care Res Rev
Actual causes of death in the United States
JAMA
The case for more active policy attention to health promotion
Health Aff (Millwood)
National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999-2001
Birth Defects Res A Clin Mol Teratol
Congenital malformations in offspring of Hispanic and African-American women in California, 1989-1997
Birth Defects Res A Clin Mol Teratol
The prevalence and predictors of anencephaly and spina bifida in Texas
Paediatr Perinat Epidemiol
Understanding the increased risk of neural tube defect-affected pregnancies among Mexico-born women in California: immigration and anthropometric factors
Paediatr Perinat Epidemiol
Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995-2002
Pediatrics
Trends in folic acid supplement intake among women of reproductive age—California, 2002-2006
MMWR Morb Mortal Wkly Rep
Population-level changes in folate intake by age, gender, and race/ethnicity after folic acid fortification
Am J Public Health
Methylenetetrahydrofolate reductase and spina bifida: evaluation of level of defect and maternal genotypic risk in Hispanics
Am J Med Genet
Presence of the 5,10-methylenetetrahydrofolate reductase C677T mutation in Puerto Rican patients with neural tube defects
J Child Neurol
Association between CFL1 gene polymorphisms and spina bifida risk in a California population
BMC Med Genet
Trisomies 13 and 18: population prevalences, characteristics, and prenatal diagnosis, metropolitan Atlanta, 1994-2003
Am J Med Genet A
Prenatal diagnosis, pregnancy terminations and prevalence of Down syndrome in Atlanta
Birth Defects Res A Clin Mol Teratol
Prenatal diagnosis and elective termination of neural tube defects in Hawaii, 1986-1997
Fetal Diagn Ther
Epidemiologic study of Down syndrome in a racially diverse California population, 1989-1991
Am J Epidemiol
Characteristics of women who refuse an offer of prenatal diagnosis: data from the California maternal serum alpha fetoprotein blood test experience
Am J Med Genet
Beyond race or ethnicity and socioeconomic status: predictors of prenatal testing for Down syndrome
Obstet Gynecol
Fetal and perinatal mortality, United States, 2004
Natl Vital Stat Rep
Early access to prenatal care: implications for racial disparity in perinatal mortality
Obstet Gynecol
Infant mortality statistics from the 2003 period linked birth/infant death data set
Natl Vital Stat Rep
The contribution of preterm birth to the black-white infant mortality gap, 1990 and 2000
Am J Public Health
Infant mortality statistics from the 2005 period linked birth/infant death data set
Natl Vital Stat Rep
Genetic contributions to disparities in preterm birth
Pediatr Res
Racial disparity in risk of preterm birth associated with lower genital tract infection
Paediatr Perinat Epidemiol
State-specific trends in U.S. live births to women born outside the 50 states and the District of Columbia—United States, 1990 and 2000
MMWR Morb Mortal Wkly Rep
Cited by (0)
This study was supported in part by National Institutes of Health/National Center for Research Resources/Office of the Director, University of California, San Francisco-Clinical and Translational Sciences Institute Grant KL2 RR024130 (to A.S.B.). A.S.B. is also supported by the Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation.
The views expressed herein are those of the authors and do not necessarily represent the official views of the National Institutes of Health.