Race, cardiovascular reactivity, and preterm delivery among active-duty military women.
BACKGROUND
Rates of preterm delivery in the United States are higher in black women compared with whites. In this study, we examined cardiovascular reactivity and risk of preterm delivery among black and white military women.


METHODS
We recruited a total of 500 black and white active-duty military women from the prenatal clinic at a large military installation, interviewing them early in pregnancy and again at 28 weeks of gestation. A subgroup of women underwent a computerized stress test to determine cardiovascular reactivity assessed as increases in heart rate and blood pressure compared with measurements taken before the stress test.


RESULTS
Despite a relatively low overall risk of preterm delivery (8.2%), we found the same 2-fold racial disparity reported in other populations (hazard ratio for preterm delivery in black women vs whites = 2.30; 95% confidence interval = 1.24-4.27). The disparity is present in all military ranks and is largest for medically indicated preterm deliveries. Among the 313 subjects who participated in the computerized stress testing, blacks exhibited more cardiac reactivity than whites. In black subjects only, a 1-mm increase in diastolic blood pressure reactivity was associated with 1.1 a day earlier delivery (-0.17 weeks). A similar trend was seen with heart rate.


CONCLUSIONS
Autonomic dysfunction after exposure to stressors may play a role in the timing of delivery among black women.
Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA. hatchm@mail.nih.gov
Maureen
M
Hatch
Gertrud
G
Berkowitz
Teresa
T
Janevic
Richard
R
Sloan
Robert
R
Lapinski
Teresa
T
James
William H
WH
Barth
D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D008889:Military Personnel; D011247:Pregnancy / Q000502:physiology*; D047928:Premature Birth / Q000208:ethnology* / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013315:Stress, Psychological / Q000208:ethnology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American