Improving social factors may mitigate race disparities in preterm birth, preeclampsia
Click Here to Manage Email Alerts
Key takeaways:
- After accounting for social factors, Black and white women had similar risk for preterm birth and preeclampsia.
- Interventions targeting race and sex discrimination may reduce disparities.
Black and white women have similar risk for preterm birth and preeclampsia when accounting for a wide range of social determinants of health, particularly socioeconomic factors, researchers reported.
“This study highlights that a significant portion of the racial and ethnic disparities in preterm birth and preeclampsia between non-Hispanic Black and non-Hispanic white women is attributable to social determinants of health,” Tetsuya Kawakita, MD, MS, associate professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, told Healio. “Our findings underscore the critical role of social determinants of health, such as socioeconomic status and access to health care, in contributing to these disparities and suggest that interventions addressing these factors may reduce adverse pregnancy outcomes.”
The findings of Kawakita and colleagues were published in O&G Open.
“We hypothesized that an analysis that included a greater number of social determinants of health variables would explain a larger percentage of, and give further insight into, racial and ethnic disparities in preterm birth and preeclampsia,” they wrote.
Researchers conducted a secondary analysis of the nuMoM2b study, a prospective cohort of more than 10,000 nulliparous women with singleton pregnancies enrolled from September 2010 to September 2013. Analyses were restricted to participants who identified as non-Hispanic Black (n = 1,321) or non-Hispanic white (n = 5,762). Women completed questionnaires that measured stress, dietary patterns, social connections or isolation and social supports. Researchers estimated the extent to which individual social determinants of health contribute to differences in the prevalence of preterm birth and preeclampsia in Black vs. white women.
Researchers found Black women were more likely to experience preterm birth compared with white women (11.6% vs. 7.7%; P < .01), as well as preeclampsia (12.3% vs. 8.2%; P < .01). Comparing social and demographic factors, Black vs. white women were more likely to have a younger mean maternal age (23.4 years vs. 28.2 years; P < .01); had less education, were more likely to have government insurance and reported greater stress levels, fewer social connections and social supports.
Before adjusting for social determinants of health and demographic factors, crude ORs for Black vs. white women were 1.57 for preterm birth of any cause (99% CI, 1.22-2.03) and 1.57 for preeclampsia (99% CI, 1.22-2.01). After adjusting for social and demographic factors, odds for preterm birth (adjusted OR = 1.08; 99% CI, 0.77-1.51) and preeclampsia (aOR = 1.2; 99% CI, 0.85-1.68) were similar for Black women compared with white women.
Researchers found social determinants of health explained 56.4% of the disparities in preterm birth and 71.2% of the disparities in preeclampsia, with socioeconomic factors making up more than half of the proportions for both outcomes. For preterm birth, alcohol consumption explained an additional 7.5% of disparities, whereas dietary pattern explained an additional 28.8% of disparities in preeclampsia.
“Clinically, these results emphasize the need for health care providers to consider the broader social and economic context in which patients live, beyond their immediate medical conditions,” Kawakita told Healio. “Targeted interventions that address social determinants of health, such as enhancing access to education and health care services, may be key in reducing disparities in pregnancy outcomes, particularly for at-risk populations like non-Hispanic Black women.”
The researchers noted that interventions targeting the root causes of maldistribution of social determinants of health, such as racism and sex discrimination, may also reduce disparities in preterm birth and preeclampsia.
“Additionally, exploring the role of environmental and geographic factors in these disparities, as well as longitudinal studies assessing the long-term health effects on mothers and infants, will be crucial,” Kawakita told Healio.
For more information:
Tetsuya Kawakita, MD, MS, can be reached at tetsuya.x.kawakita@gmail.com; X (Twitter): @tetsuyakawakit.