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Risk of Extreme, Moderate, and Late Preterm Birth by Maternal Race, Ethnicity, and Nativity

  • Author Footnotes
    ∗ Contributed equally.
    Teniola I. Egbe
    Correspondence
    Reprint requests: Teniola I. Egbe, MPH, MBE, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South St, 10th Floor–10264, Philadelphia, PA 19146
    Footnotes
    ∗ Contributed equally.
    Affiliations
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Search for articles by this author
  • Author Footnotes
    ∗ Contributed equally.
    Diana Montoya-Williams
    Footnotes
    ∗ Contributed equally.
    Affiliations
    Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA

    Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
    Search for articles by this author
  • Kate Wallis
    Affiliations
    Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA

    Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
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  • Molly Passarella
    Affiliations
    Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
    Search for articles by this author
  • Scott A. Lorch
    Affiliations
    Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA

    Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
    Search for articles by this author
  • Author Footnotes
    ∗ Contributed equally.
Published:September 27, 2021DOI:https://doi.org/10.1016/j.jpeds.2021.09.035

      Objectives

      To explore the relative risks of preterm birth—both overall and stratified into 3 groups (late, moderate, and extreme prematurity)—associated with maternal race, ethnicity, and nativity (ie, birthplace) combined.

      Study design

      This was a retrospective cross-sectional cohort study of women delivering a live birth in Pennsylvania from 2011 to 2014 (n = 4 499 259). Log binomial and multinomial regression analyses determined the relative risks of each strata of preterm birth by racial/ethnic/native category, after adjusting for maternal sociodemographic, medical comorbidities, and birth year.

      Results

      Foreign-born women overall had lower relative risks of both overall preterm birth and each strata of prematurity when examined en bloc. However, when considering maternal race, ethnicity, and nativity together, the relative risk of preterm birth for women in different racial/ethnic/nativity groups varied by preterm strata and by race. Being foreign-born appeared protective for late prematurity. However, only foreign-born White women had lower adjusted relative risks of moderate and extreme preterm birth compared with reference groups. All ethnic/native sub-groups of Black women had a significantly increased risk of extreme preterm births compared with US born non-Hispanic White women.

      Conclusions

      Race, ethnicity, and nativity contribute differently to varying levels of prematurity. Future research involving birth outcome disparities may benefit by taking a more granular approach to the outcome of preterm birth and considering how nativity interacts with race and ethnicity.

      Keywords

      Abbreviation:

      aRR (Adjusted relative risk)
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