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

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.

Automated summary

This retrospective study in Pennsylvania found that foreign-born women overall had lower relative risks of preterm birth, but the risk varied by preterm strata and by race when considering maternal race, ethnicity, and nativity. It suggests that race, ethnicity, and nativity contribute differently to varying levels of prematurity. Further research may benefit from a more detailed approach to studying preterm birth outcomes and considering the interaction between nativity, race, and ethnicity.