Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020.

Importance: Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. Objective: To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. Design, Setting, and Participants: Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. Exposures: Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. Main Outcomes and Measures: Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. Results: Of 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. Conclusions and Relevance: From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.

Black race associated with lower live birth rate in frozen-thawed blastocyst transfer cycles: an analysis of 7,002 Society for Assisted Reproductive Technology frozen-thawed blastocyst transfer cycles.

OBJECTIVE: To evaluate if racial/ethnic differences in pregnancy outcomes persisted in frozen-thawed embryo transfer (FET) cycles on a national level. DESIGN: Retrospective cohort study. SETTING: Clinic-based data. PATIENT(S): A total of 189,000 Society for Assisted Reproductive Technology FET cycles from 2014-2016 were screened, of which 12,000 cycles had available fresh cycle linkage information and ultimately, because of missing data, 7,002 FET cycles were included. Cycles were stratified by race (White, Black, Asian, and Hispanic). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The primary outcome was live birth rate. Secondary outcomes were implantation rate, clinical pregnancy rate, multiple pregnancy rate, and clinical loss rate (CLR). RESULT(S): Live birth rate was significantly lower in the Black vs. White and Asian, but not Hispanic group. Implantation rate was also significantly lower and CLR higher in the Black group compared with all other groups (all P<.01). Black women had a lower risk of live birth (adjusted risk ratio, 0.82; 95% confidence interval [CI], 0.73-0.92) and a higher risk of clinical loss (adjusted risk ratio, 1.59; 95% CI, 1.28-1.99) compared with White women. There was no significant difference between groups in clinical pregnancy rate or multiple pregnancy rate. When the analysis was limited to preimplantation genetic testing FET cycles, there remained a significantly lower implantation rate in the Black group compared with all other groups (all P<.01). CONCLUSION(S): Black race remains an independent predictor of reduced live birth rate in FET cycles, likely because of higher CLR.

Reproductive and obstetric outcomes in women of racial minorities aged 40 years and older undergoing IVF.

RESEARCH QUESTION: Do women of racial minorities aged 40 years or older have similar reproductive and obstetric outcomes as white women undergoing IVF? DESIGN: A retrospective cohort study conducted at a single academic university-affiliated centre. The study population included women aged 40 years or older undergoing their first IVF cycle with fresh cleavage-stage embryo transfer stratified by racial minority status: minority (black or Asian) versus white. Clinical intrauterine pregnancy and live birth rate were the primary outcomes. Preterm delivery (<37 weeks) and small for gestational age were the secondary outcomes. Odds ratios with 95% confidence intervals were estimated. P < 0.05 was considered to be statistically significant. RESULTS: A total of 2050 cycles in women over the age of 40 years were analysed, 561 (27.4%) of which were undertaken by minority women and 1489 (72.6%) by white women. Minority women were 30% less likely to achieve a pregnancy compared with their white (non-Hispanic) counterparts (adjusted OR 0.68, CI 0.54 to 0.87). Once pregnant, however, the odds of live birth were similar (adjusted OR 1.23, CI 0.91 to 1.67). Minority women were significantly more likely to have lower gestational ages at time of delivery (38.5 versus 39.2 weeks, P = 0.009) and were more likely to have extreme preterm birth delivery 24-28 weeks (5.5 versus 1.0%, P = 0.021). CONCLUSION: Minority women of advanced reproductive age are less likely to achieve a pregnancy compared with white (non-Hispanic) women. Once pregnancy is achieved, however, live birth rates are similar albeit with minority women experiencing higher rates of preterm delivery.

Reproductive Health Disparities in the USA: Self-Reported Race/Ethnicity Predicts Age of Menarche and Live Birth Ratios, but Not Infertility.

Self-identified race/ethnicity and socioeconomic status (SES) contribute to disparities in several health domains, although research on their effects on women's reproductive function has largely focused on links between SES and age of menarche. Here, we assessed whether race/ethnicity, SES, and downstream correlates of SES such as food security and health-insurance security are associated with age of menarche, infertility, and live birth ratios (ratios of recognized pregnancies resulting in live births) in the USA. We used cross-sectional data from 1694 women aged 12-18 years for menarche (2007-2016), 974 women aged 23-45 for infertility (2013-2016), and 1714 women aged 23-45 for live birth ratios (2007-2016) from the National Health and Nutrition Examination Survey. We estimated multiple linear and logistic regressions with survey weights to test these associations. When controlling for lifestyle (activity levels, smoking, alcohol consumption) and physiological factors (diabetes, weight status), non-Hispanic (NH) black and Hispanic girls reported a significantly lower age of menarche by about 4.3 (standard error [SE] = 0.08, p < 0.001), and 3.2 months (SE = 0.09, p < 0.001), respectively, relative to NH white girls. NH black women reported live birth ratios 9% (SE = 0.02, p < 0.001) lower than NH white women. Women with unstable health insurance reported live birth ratios 6% (SE = 0.02, p = 0.02) lower than women with stable health insurance. Race/ethnicity, SES, and its downstream correlates were not associated with infertility. One hypothesized explanation for observed disparities in age of menarche and live birth ratios is the embodiment of discrimination faced by NH black women within the USA. Our findings also underscore the importance of health insurance access for favorable reproductive health outcomes. Future work should elucidate the role of embodied discrimination and other downstream correlates of SES in modulating women's reproductive health outcomes to inform strategies to mitigate health disparities.

To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort.

Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011-2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.

Adolescent Interpregnancy Interval in Colorado Among Women With a Last Live Birth Between 2004 and 2013.

PURPOSE: The purpose of the article was to determine risk factors associated with interpregnancy interval (IPI) and how IPI is associated with subsequent pregnancy outcomes. METHODS: We performed bivariate and multivariable analyses of the Colorado Birth Certificate Registry data from women with a last live birth from 2004 to 2013, among Coloradan women aged 19 years and younger. RESULTS: Our multivariate analysis found that older adolescents aged 17-19 years had a reduced likelihood of an IPI >18 months (odds ratio [OR] .8; confidence interval [CI] .7-.9). Self-identifying as Hispanic increased the likelihood of an IPI <18 months, whereas delivering during or after 2009 or having Medicaid insurance significantly increased the odds that an adolescent would have an IPI >18 months (OR 1.5 [CI: 1.4-1.6]; OR 1.2 [CI: 1.1-1.2]; OR 1.5 [CI: 1.4-1.6], respectively). We found that an IPI >18 months was associated with the following dependent variables in unique logistic regressions adjusted for age, ethnicity, year of last live birth, and insurance status: reduced risk of neonatal complications (OR .9 [CI: .8-.9]), reduced risk of overweight/obesity (OR .9 [CI: .8-.9]), and an increased likelihood of normal birthweight (OR 1.2 [CI: 1.1-1.4]), term birth (OR 1.3 [CI: 1.1-1.4]), and attending 14 or more prenatal visits (OR 1.3 [CI: 1.2-1.4]. CONCLUSIONS: Having an IPI >18 months in adolescent Coloradan women is associated with an increased likelihood of prenatal care attendance, term birth, and normal birthweight and with a reduced likelihood of neonatal complications.

Stillbirth and Live Birth at Periviable Gestational Age: A Comparison of Prevalence and Risk Factors.

OBJECTIVE: We compared the prevalence of and risk factors for stillbirth and live birth at periviable gestational age (20-25 weeks). STUDY DESIGN: This is a cohort study of 2.5 million singleton births in California from 2007 to 2011. We estimated racial-ethnic prevalence ratios and used multivariable logistic regression for risk factor comparisons. RESULTS: In this study, 42% of deliveries at 20 to 25 weeks' gestation were stillbirths, and 22% were live births who died within 24 hours. The prevalence of delivery at periviable gestation was 3.4 per 1,000 deliveries among whites, 10.9 for blacks, 3.5 for Asians, and 4.4 for Hispanics. Nonwhite race-ethnicity, lower education, uninsured status, being U.S. born, older age, obesity, smoking, pre-pregnancy hypertension, nulliparity, interpregnancy interval, and prior preterm birth or stillbirth were all associated with increased risk of both stillbirth and live birth at 20 to 25 weeks' gestation, compared with delivery of a live birth at 37 to 41 weeks. CONCLUSION: Inclusion of stillbirths and live births in studies of deliveries at periviable gestations is important.

Sex ratios at birth among second-generation mothers of South Asian ethnicity in Ontario, Canada: a retrospective population-based cohort study.

BACKGROUND: Son-biased sex ratios at birth (M:F), an extreme manifestation of son preference, are predominately found in East and South Asia. Studies have examined sex ratios among first-generation migrants from these regions, but few have examined second-generation descendants. Our objective was to determine whether son-biased sex ratios persist among second-generation mothers with South Asian ethnicity in Ontario, Canada. METHODOLOGY: A surname algorithm identified a population-based cohort of mothers with South Asian ethnicity who gave birth in Ontario between 1993 and 2014 (n=59 659). Linking to official immigration data identified births to first-generation mothers (ie, immigrants). Births not to immigrants were designated as being to second-generation mothers (ie, born in Canada) (n=10 273). Sex ratios and 95% CI were stratified by the sex of previous live births and by whether it was preceded by ≥1 abortion for both first-generation and second-generation mothers. RESULTS: Among mothers with two previous daughters and at least one prior abortion since the second birth, both second-generation mothers and first-generation mothers had elevated sex ratios at the third birth (2.80 (95% CI 1.36 to 5.76) and 2.46 (95% CI 1.93 to 3.12), respectively). However, among mothers with no prior abortion, second-generation mothers had a normal sex ratio, while first-generation mothers gave birth to 142 boys for every 100 girls (95% CI 125 to 162 boys for every 100 girls). CONCLUSION: Son preference persists among second-generation mothers of South Asian ethnicity. Culturally sensitive and community-driven gender equity interventions are needed.

Contribution of previable live births to disparity in infant mortality of US-born Puerto Ricans compared with infants of other Hispanic origins.

OBJECTIVES: Although US-born Hispanics experience infant mortality rates (IMRs) which are lower than the national rate, within the Hispanic population, infants of Puerto Rican origin experience higher IMRs than other Hispanics. We aimed to describe the contribution of deaths among previable live-born infants to disparity in IMRs comparing Puerto Rican infants to infants of other Hispanic origins. STUDY DESIGN: Retrospective, descriptive analysis. METHODS: We analyzed data from the Centers for Disease Control and Prevention (CDC) WONDER online database representing linked US live births and infant deaths from 2005 to 2014. Data were stratified by race and ethnicity as well as by Puerto Rican and non-Puerto Rican Hispanic origin. Live births <23 weeks of gestation were classified as previable. Ten-year IMRs were calculated as the number of deaths divided by the number of live births for each group over the entire decade. RESULTS: Puerto Rican IMR of 7.34 (per 1000 live births) was higher than the US rate of 6.34 as well as the non-Puerto Rican Hispanic IMR of 5.15. Approximately 22% of US deaths were attributable to previable live births compared with 27% among Puerto Ricans and 20% among non-Puerto Rican Hispanics. The contribution to IMR of previable births among Puerto Ricans measuring 1.96 per 1000 total live births was 42% higher than the US rate of 1.38 and 90% higher than the non-Puerto Rican Hispanic rate of 1.03. CONCLUSIONS: Further research is needed to develop interventions to reduce disparity in previable birth rates, particularly among infants of Puerto Rican origin.

Effect of race and ethnicity on utilization and outcomes of assisted reproductive technology in the USA.

BACKGROUND: The purpose of this study was to determine the utilization and live birth rates of assisted reproductive technology (ART) modalities among various racial and ethnic groups in recent years. METHODS: We reviewed ART data reported to the Society for Assisted Reproductive Technologies Clinic Outcome Reporting System (SART CORS) for autologous ART and third-party ART (3ART) cycles which involved donor oocytes, sperm, embryos and gestational carrier, performed in the U.S. between 2004 and 2013. To gauge demand by various racial/ethnic groups for ART services, we examined fertility rates and demographics of the entire U.S. birth cohort over the same time interval. RESULTS: Of 1,132,844 autologous ART cycles 335,462 resulted in a live birth (29.6%). An additional, 217,030 3ART cycles resulted in 86,063 live births (39.7%). Hispanic and Black women demonstrated high fertility and lower utilization rates of autologous ART and 3ART. Caucasian and Asian women exhibited lower fertility rates and higher autologous ART and 3ART utilization. Autologous ART resulted in higher live birth rates among Caucasian and Hispanic women and lower rates among Asian and especially Black women. 3ART improved live birth rates in all races/ethnicities, though Black women experienced lower live birth rates with most modalities. Spontaneous abortion rates were higher among Black women following autologous ART and some 3ART modalities than those among Caucasian women. CONCLUSION: Utilization of ART is inversely related to fertility rates. Autologous ART produces lower live birth rates among Asian and Black women. 3ART results in relatively low live birth rates among Black women. TRIAL REGISTRATION: SART CORS #57 , Registered 5/14/2015.

Sex Ratios at Birth Among Indian Immigrant Subgroups According to Time Spent in Canada.

OBJECTIVES: To examine whether son-biased male to female (M:F) ratios at birth among linguistically different subgroups of Indian immigrants vary according to duration of residence in Canada. METHODS: We analyzed a retrospective cohort of 46 834 live births to Indian-born mothers who gave birth in Canada between 1993 and 2014. The M:F ratio at birth was calculated according to the sex of previous live births and stratified by (1) time since immigration to Canada (<10 and ≥10 years) and (2) mother tongue (Punjabi, Gujarati, Hindi, and other). We estimated adjusted odds ratios (aORs) using multivariate logistic regression to assess the probability of having a male newborn with 5-year increases in duration of residence in Canada for each language group. ORs were adjusted for married status, knowledge of English/French, maternal education at arrival and age and neighbourhood income at delivery. RESULTS: Among all Indian immigrant women with two previous daughters, M:F ratios were higher than expected (1.92, 95% CI 1.73-2.12), particularly among those whose mother tongue was Punjabi (n = 25 287) (2.40, 95% CI 2.11-2.72) and Hindi (n = 7752) (1.63, 95% CI 1.05-2.52). M:F ratios did not diminish with longer duration in Canada (Punjabi 5-year aOR 1.03, 95% CI 0.81-1.31; Hindi 5-year aOR 0.94, 95% CI 0.42-2.17). CONCLUSION: Among the Punjabi and Hindi women with two previous daughters, longer duration of residence did not attenuate son-biased M:F ratios at the third birth. Gender equity promotion may focus on Punjabi- and Hindi-speaking Indian immigrant women regardless of how long they have lived in Canada.

Estimation of the number of people with Down syndrome in the United States.

PURPOSE: An accurate accounting of persons with Down syndrome (DS) has remained elusive because no population-based registries exist in the United States. The purpose of this study was to estimate this population size by age, race, and ethnicity. METHODS: We predicted the number of people with DS in different age groups for different calendar years using estimations of the number of live births of children with DS from 1900 onward and constructing DS-specific mortality rates from previous studies. RESULTS: We estimate that the number of people with DS living in the United States has grown from 49,923 in 1950 to 206,366 in 2010, which includes 138,019 non-Hispanic whites, 27,141 non-Hispanic blacks, 32,933 Hispanics, 6,747 Asians/Pacific Islanders, and 1,527 American Indians/American Natives. Population prevalence of DS in the United States, as of 2010, was estimated at 6.7 per 10,000 inhabitants (or 1 in 1,499). CONCLUSION: Until 2008, DS was a rare disease. In more recent decades, the population growth of people with DS has leveled off for non-Hispanic whites as a consequence of elective terminations. Changes in childhood survival have impacted the age distribution of people with DS, with more people in their fourth, fifth, and sixth decades of life.Genet Med 19 4, 439-447.

Effect of ethnicity on live birth rates after in vitro fertilisation/intracytoplasmic sperm injection treatment: analysis of UK national database.

OBJECTIVE: To evaluate the effect of ethnicity of women on the outcome of in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment. DESIGN: Observational cohort study. SETTING: UK National Database. POPULATION: Data from 2000 to 2010 involving 38 709 women undergoing their first IVF/ICSI cycle were analysed. METHODS: Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of IVF and ICSI treatment in the UK. Data analysis was performed by regression analysis with adjustment for age, cause and type of infertility and treatment type (IVF or ICSI) to express results as odds ratio (OR) and 95% confidence intervals (95% CI). METHODS: Live birth rate per cycle of IVF or ICSI treatment. RESULTS: While white Irish (OR 0.73; 95% CI 0.60-0.90), Indian (0.85; 0.75-0.97), Bangladeshi (0.53: 0.33-0.85), Pakistani (0.68; 0.58-0.80), Black African (0.60; 0.51-0.72), and other non-Caucasian Asian (0.86; 0.73-0.99) had a significantly lower odds of live birth rates per fresh IVF/ICSI cycle than White British women, ethnic groups of White European (1.04; 0.96-1.13), Chinese (1.12; 0.77-1.64), Black Caribbean (0.76; 0.51-1.13), Middle Eastern (0.73; 0.51-1.04), Mediterranean European (1.18; 0.83-1.70) and Mixed race population (0.94; 0.73-1.19) had live birth rates that did not differ significantly. The cumulative live birth rates showed similar patterns across different ethnic groups. CONCLUSION: Ethnicity is a major determinant of IVF/ICSI treatment outcome as indicated by significantly lower live birth rates in some of the ethnic minority groups compared with white British women. TWEETABLE ABSTRACT: Ethnicity affects IVF outcome with lower live birth rates in some ethnic groups more than in white British.

Birth weight in live births and stillbirths.

OBJECTIVE: To establish a normal range of birth weights for gestational age at delivery and to compare the proportion of live births and stillbirths that are classified as small-for-gestational age (SGA) according to our normal range vs that of the INTERGROWTH-21st standard. METHODS: The study population comprised 113 019 live births and 437 (0.4%) stillbirths. The inclusion criterion for establishing a normal range of birth weights for gestational age was the live birth of a phenotypically normal neonate ≥ 24 weeks' gestation and the exclusion criteria were smoking and prepregnancy hypertension, diabetes mellitus, systemic lupus erythematosus or antiphospholipid syndrome, pre-eclampsia, gestational hypertension, gestational diabetes mellitus or iatrogenic preterm birth for fetal growth restriction in the current pregnancy. Inclusion criteria were met by 92 018 live births. The proportions of live births and stillbirths with birth weights < 5th and < 10th percentiles of our normal range and those according to the INTERGROWTH-21st standard were determined and compared by the chi-square test and McNemar test. RESULTS: The proportions of live births and stillbirths with a birth weight < 5th percentile according to our standard were significantly higher than and discordant with the proportion according to the INTERGROWTH-21st standard (live birth: 5.6% vs 3.4%; stillbirth: 37.2% vs 22.7%). Similarly, the proportion of live births and stillbirths with a birth weight < 10th percentile according to our standard were significantly higher than and discordant with those according to the INTERGROWTH-21st standard (live birth: 11.2% vs 6.9%; stillbirth: 44.3% vs 32.6%). CONCLUSION: The INTERGROWTH-21st standard underestimates the proportion of SGA live births and stillbirths in our population. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Prepregnancy obesity and the racial disparity in infant mortality.

OBJECTIVE: To estimate the extent to which prepregnancy obesity explains the Black-White disparity in stillbirth and infant mortality. METHODS: A population-based study of linked Pennsylvania birth-infant death certificates (2003-2011; n = 1,055,359 births) and fetal death certificates (2006-2011; n = 3,102 stillbirths) for all singleton pregnancies in non-Hispanic (NH) White and NH Black women was conducted. Inverse probability weighted regression was used to estimate the role of prepregnancy obesity in explaining the race-infant/fetal death association. RESULTS: Compared with NH White women, NH Black women were more likely to have obesity (≥30 kg/m2 ) and experienced a higher rate of stillbirth (8.3 vs. 3.6 stillbirths per 1,000 live-born and stillborn infants) and infant death (8.5 vs. 3.0 infant deaths per 1,000 live births). When the contribution of prepregnancy obesity was removed, the difference in risk between NH Blacks and NH Whites decreased from 6.2 (95% CI: 5.6-6.7) to 5.5 (95% CI: 4.9-6.2) excess stillbirths per 1,000 and 5.8 (95% CI: 5.3-6.3) to 5.2 (95% CI: 4.7-5.7) excess infant deaths per 1,000. CONCLUSIONS: For every 10,000 live births in Pennsylvania (2003-2011), 6 of the 61 excess infant deaths in NH Black women and 5 of the 44 excess stillbirths (2006-2011) were attributable to prepregnancy obesity.

Racial disparity in previable birth.

BACKGROUND: Extremely preterm birth of a live newborn before the limit of viability is rare but contributes uniformly to the infant mortality rate because essentially all cases result in neonatal death. OBJECTIVE: The objective of the study was to quantify racial differences in previable birth and their contribution to infant mortality and to estimate the relative influence of factors associated with live birth occurring before the threshold of viability. STUDY DESIGN: This was a population-based retrospective cohort of all live births in Ohio over a 7 year period, 2006-2012. Demographic, pregnancy, and delivery characteristics of previable live births at 16 0/7 to 22 6/7 weeks of gestation were compared with a referent group of live births at 37 0/7 to 42 6/7 weeks. Rates of birth at each week of gestation were compared between black and white mothers, and relative risk ratios were calculated. Logistic regression estimated the relative risk of factors associated with previable birth, with adjustment for concomitant risk factors. RESULTS: Of 1,034,552 live births in Ohio during the study period, 2607 (0.25% of all live births) occurred during the previable period of 16-22 weeks. There is a significant racial disparity in the rate and relative risk of previable birth, with a 3- to 6-fold relative risk increase in black mothers at each week of previable gestational age. The incidence of previable birth for white mothers was 1.8 per 1000 and for black mothers, 6.9 per 1000. Factors most strongly associated with previable birth, presented as adjusted relative risk ratio (95% confidence interval [CI]), were maternal characteristics of black race adjusted relative risk 2.9 (95% CI, 2.6-3.2), age ≥ 35 years 1.3 (95% CI, 1.1-1.6), and unmarried 2.1 (95% CI, 1.8-2.3); fetal characteristics including congenital anomaly, 5.4 (95% CI, 3.4-8.1) and genetic disorder, 5.1 (95% CI, 2.5-10.1); and pregnancy characteristics including prior preterm birth 4.4 (95% CI, 3.7-5.2) and multifetal gestation, twin, 16.9 (95% CI, 14.4-19.8) or triplet, 65.4 (95% CI, 32.9-130.2). The majority, 80%, of previable births (16-22 weeks) were spontaneous in nature, compared with 73% in early preterm births (23-33 weeks), 72% in late preterm births (34-36 weeks), and 65% of term births (37-42 weeks) (P < .001). Previable births constituted approximately 28% of total infant mortalities in white newborns and 45% of infant mortalities in black infants in Ohio during the study period. CONCLUSION: There is a significant racial disparity in previable preterm births, with black mothers incurring a 3- to 6-fold increased relative risk compared with white mothers, most of which are spontaneous in nature. This may explain much of the racial disparity in infant mortality because all live-born previable preterm births result in death. Focused efforts on the prevention of spontaneous previable preterm birth may help to reduce the racial disparity in infant mortality.

Hepatitis C virus seroprevalence in pregnant women delivering live-born infants in North Thames, England in 2012.

To estimate HCV seroprevalence in subpopulations of women delivering live-born infants in the North Thames region in England in 2012, an unlinked anonymous (UA) cross-sectional survey of neonatal dried blood spot samples was conducted. Data were available from 31467 samples from live-born infants received by the North Thames screening laboratory. Thirty neonatal samples had HCV antibodies, corresponding to a maternal seroprevalence of 0·095% (95% confidence interval 0·067-0·136). Estimated HCV seroprevalences in women born in Eastern Europe, Southern Asia and the UK were 0·366%, 0·162% and 0·019%, respectively. For women born in Eastern Europe seroprevalence was highest in those aged around 27 years, while in women born in the UK and Asia-Pacific region, seroprevalence increased significantly with age. HCV seroprevalence in UK-born women whose infant's father was also UK-born was 0·016%. One of the 30 HCV-seropositive women was HIV-1 seropositive. Estimated HCV seroprevalence for women delivering live-born infants in North Thames in 2012 (0·095%) was significantly lower than that reported in an earlier UA survey in 1997-1998 (0·191%). Data indicate that the cohort of UK-born HCV-seropositive women is ageing and that, in this area of England, most perinatally HCV-exposed infants were born to women themselves born in Southern Asia or Eastern Europe.

Racial disparities in in vitro fertilization outcomes.

OBJECTIVE: To evaluate the impact of race on in vitro fertilization (IVF) outcomes. DESIGN: Retrospective analysis. SETTING: Private practice. PATIENT(S): All women who underwent a first autologous IVF cycle at Fertility Centers of Illinois from January 2010 to December 2012. INTERVENTION(S): Information was collected on baseline characteristics, cycle parameters, and outcomes. Race was self-reported. MAIN OUTCOME MEASURE(S): Clinical intrauterine pregnancy and live birth rates. RESULT(S): A total of 4,045 women were included: 3,003 white (74.2%), 213 black (5.3%), 541 Asian (13.4%), and 288 Hispanic women (7.1%). A multivariable logistic regression was performed to control for confounders. Compared with white women, the adjusted odds ratio for clinical intrauterine pregnancy was 0.63 (95% confidence interval [CI] 0.44-0.88) in black women, 0.73 (95% CI 0.60-0.90) in Asian women, and 0.82 (95% CI 0.62-1.07) in Hispanic women. The adjusted odds ratio for live birth was 0.50 (95% CI 0.33-0.72) in black women, 0.64 (95% CI 0.51-0.80) in Asian women, and 0.80 (95% CI 0.60-1.06) in Hispanic women compared with white women. The spontaneous abortion rate was 14.6% in white women versus 28.9% in black women, 20.6% in Asian women, and 15.3% in Hispanic women. CONCLUSION(S): Black and Asian women had lower odds of clinical intrauterine pregnancy and live birth and higher rates of spontaneous abortion compared with white women. Further research is needed to better characterize the mechanisms associated with this racial disparity and to improve treatment options for black and Asian women.

Prevalence of birth defects among American-Indian births in California, 1983-2010.

BACKGROUND: Approximately 6.3 million live births and fetal deaths occurred during the ascertainment period in the California Birth Defects Monitoring Program registry. American-Indian and non-Hispanic white women delivered 40,268 and 2,044,118 births, respectively. While much information has been published about non-Hispanic white infants, little is known regarding the risks of birth defects among infants born to American-Indian women. METHODS: This study used data from the California Birth Defects Monitoring Program to explore risks of selected birth defects in offspring of American-Indian relative to non-Hispanic white women in California. The study population included all live births and fetal deaths 20 weeks or greater from 1983 to 2010. Prevalence ratios and corresponding 95% confidence intervals (CI) were computed using Poisson regression for 51 groupings of birth defects. RESULTS: Prevalence ratios were estimated for 51 groupings of birth defects. Of the 51, nine had statistically precise results ranging from 0.78 to 1.85. The eight groups with elevated risks for American-Indian births were reduction deformities of brain, anomalies of anterior segments, specified anomalies of ear, ostium secundum type atrial septal defect, specified anomalies of heart, anomalies of the aorta, anomalies of great veins, and cleft lip with cleft palate. CONCLUSION: Our results suggest that American-Indian women having babies in California may be at higher risk for eight birth defect phenotypes compared with non-Hispanic whites. Further research is needed to determine whether these risks are observed among other populations of American-Indian women or when adjusted for potential covariates.

The validity of birth and pregnancy histories in rural Bangladesh.

BACKGROUND: Maternity histories provide a means of estimating fertility and mortality from surveys. METHODS: The present analysis compares two types of maternity histories-birth histories and pregnancy histories-in three respects: (1) completeness of live birth and infant death reporting; (2) accuracy of the time placement of live births and infant deaths; and (3) the degree to which reported versus actual total fertility measures differ. The analysis covers a 15-year time span and is based on two data sources from Matlab, Bangladesh: the 1994 Matlab Demographic and Health Survey and, as gold standard, the vital events data from Matlab's Demographic Surveillance System. RESULTS: Both histories are near perfect in live-birth completeness; however, pregnancy histories do better in the completeness and time accuracy of deaths during the first year of life. CONCLUSIONS: Birth or pregnancy histories can be used for fertility estimation, but pregnancy histories are advised for estimating infant mortality.