Racial and ethnic disparity in male preterm singleton birth.

OBJECTIVE: To evaluate the association between male sex and increased preterm birth (PTB) by race and ethnicity among singleton fetuses born in the United States. STUDY DESIGN: The 2002 National Center for Health Statistics Natality database was analyzed for known risk factors of PTB by fetal sex and race. Multivariable Cox proportional hazards regression was applied to estimate the hazard ratio by fetal sex for births between 20 and 36 completed gestational weeks. The multivariable model was adjusted for known demographic, medical and obstetric risk factors for PTB. Subgroup analysis was performed using both race and ethnicity. RESULTS: In the overall analysis 3,853,678 singleton live births were included. PTBs between 20 and 36 completed weeks occurred in 10.9% of male and 9.8% of female infants. The association between PTB and male sex persisted after adjustment for other risk factors and did not vary by gestational age (hazard ratio [HR] 1.13, 95% CI 1.12-1.14). This association was seen in all racial and ethnic groups. This effect was less prominent among black infants (HR 1.06, 95% CI 1.04-1.07). Male fetuses with Hispanic ethnicity had a significantly higher risk of preterm birth (HR 1.15, 95% CI 1.13-1.17) compared to male fetuses of non-Hispanic ethnicity (HR 1.12, 95% CI 1.12-1.13). CONCLUSION: In the U.S. male fetuses are at higher risk for PTB compared with female fetuses at the same gestational age. The etiology of this difference is unclear, but the effect is reduced for black compared to white fetuses and increased for Hispanic fetuses.

The contribution of maternal race/ethnicity and fetal sex to prematurity in twins.

OBJECTIVE: The contribution of male fetal sex to twin preterm birth (PTB) rates was evaluated in the United States. STUDY DESIGN: The 2002 National Center for Health Statistics Natality database was analyzed for fetal sex and twin gestations based on birth sex for MM and FF pairs (M, male; F, female). Multivariable Cox proportional hazards regression was applied to estimate the hazard ratio for PTB with adjustments for known risks. RESULTS: Thirty-three thousand nine hundred twenty-six pairs were analyzed. PTBs between 20-36 completed weeks occurred in 59.1% MM pairs and 57.5% FF pairs. MM sex was an independent risk factor for PTB. This effect was greatest for deliveries between 20-29 weeks (hazard ratio, 1.224; 95% CI, 1.113-1.346). The effect was most pronounced in non-Hispanic white MM pairs. CONCLUSION: In the United States, MM pairs are at greater risk for PTB. Race and ethnicity modulate sex effects. Further studies are needed to understand potential mechanisms.

Varicella zoster meningitis in a pregnant woman with acquired immunodeficiency syndrome.

Between 6000 and 7000 women in the United States infected with human immunodeficiency virus (HIV) give birth annually. It is well known that HIV-related immunosuppression significantly increases the risk for acquiring opportunistic infections (OIs). However, there is limited information regarding the relationship of pregnancy in the setting of HIV/AIDS infection, subsequent development of OIs, and maternal and fetal outcomes. A pregnant 36-year-old woman with AIDS was diagnosed with varicella zoster meningitis. Weight-based therapy with acyclovir was initiated with clinical improvement in symptoms. Care of a pregnant HIV-infected patient with an OI poses a unique diagnostic and therapeutic challenge for clinicians. Early diagnosis and initiation of appropriate treatment may provide an opportunity to improve both maternal and fetal outcomes.