Racial Disparities in Delivery Gestational Age among Twin Pregnancies

Jacqueline H. Grant; Catherine J. Vladutiu; Tracy A. Manuck

doi:10.1055/s-0037-1603764

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(11): 1065-1071
DOI: 10.1055/s-0037-1603764

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Racial Disparities in Delivery Gestational Age among Twin Pregnancies

Authors

Jacqueline H. Grant

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
Catherine J. Vladutiu

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
Tracy A. Manuck

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina

Abstract

Objective This study aims to estimate the association between maternal race and delivery gestational age among women with twin gestations.

Study Design Secondary analysis of a prospective, randomized control trial of 17-α hydroxyprogesterone caproate versus placebo for preterm birth (PTB) prevention in twin gestations. Non-Hispanic (NH) black and whites were included. Demographic and antenatal characteristics were compared. The primary outcome was delivery gestational age. Secondary outcomes included a composite of major neonatal morbidity. Kaplan–Meier curves estimated survival probabilities for delivery gestational age by race. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI).

Results A total of 535 women with twin gestations were included; 150 were NH black. NH blacks delivered earlier than NH whites (33.6 ± 4.8 weeks vs. 35.1 ± 3.5 weeks, p < 0.001). Differences in delivery gestational age between NH blacks and whites were consistent across gestation. In adjusted analyses, NH black race (HR: 1.24, 95% CI: 1.02–1.51), prior PTB (HR: 1.59, 95% CI: 1.15–2.19), and cerclage (HR: 3.90, 95% CI: 2.00–7.60) were associated with an increased risk of earlier delivery. Major neonatal morbidity was higher for NH blacks compared with NH whites (12.7 vs. 7.0%, p = 0.036).

Conclusion NH blacks with twin gestations have an increased risk of early delivery and neonatal morbidity compared with NH whites.

Keywords

preterm birth - health disparities - twins

Full Text

References

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