title: The influence of race on fetal outcome.
abstract: The purpose of this study was to examine racial differences in fetal death by gestational age among South Carolinians during 1999 to 2000 in an attempt to identify sociodemographic risk factors that may contribute to the refinement of care protocols. This historical cohort design appended the 1999 to 2000 South Carolina Vital Records fetal death file (N = 944) to the birth file (N = 99, 726) to perform secondary data analysis. Inclusion criteria were maternal South Carolina residency, delivery of a singleton in South Carolina, and racial identification as white or black. Independent associations between race (black or white), gestational age categories of deliveries (fetal death or live birth), and maternal sociodemographic characteristics (maternal age and prenatal care) were examined using chi2 analysis. Black and white fetal mortality rates (FMRs) were examined. Logistic regression was used to control for confounding variables. The study sample consisted of 63.4% white and 36.6% black for all deliveries; 40.89% white and 59.11% black for fetal deaths. There was a significant racial difference in gestational age categories, initiation of prenatal care, maternal age, and fetal death rates (p = 0.0001). The black FMR was nearly 2.5 times greater than the white rate (p < 0.0001; 95% confidence interval, 2.2 to 2.9). There was an independent association between race and gestational age at fetal death (p = 0.0001) as well as race and maternal age. Results did not remain statistically significant after controlling for confounding variables. In this study, we identified several factors associated with an increased risk of fetal death. However, after controlling for gestational age, the odds of fetal death among blacks were no longer significantly elevated in comparison to those of whites. Future studies that examine racial disparities should consider gestational age in analytic models. Identifying racial demographics and behavioral risks may contribute to refinements in care protocols for high-risk mothers in an effort to reduce fetal mortality.
authors.affiliation: Medical University of South Carolina, College of Nursing, Charleston, South Carolina 29425, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Allen
authors.forename: Tara M
authors.initials: TM
authors.lastname: Hulsey
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Hulsey
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005313:Fetal Death / Q000208:ethnology*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology