Early access to prenatal care: implications for racial disparity in perinatal mortality.
OBJECTIVE
To investigate racial disparities in perinatal mortality in women with early access to prenatal care.


METHODS
A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals.


RESULTS
The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8).


CONCLUSIONS
Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care.


METHODS
II-2.
Healy
Andrew J
AJ
Columbia University Medical Center, 622 West 168th Street, PH-16, New York, NY 10032, USA. ajh2102@columbia.edu
Malone
Fergal D
FD
Sullivan
Lisa M
LM
Porter
T Flint
TF
Luthy
David A
DA
Comstock
Christine H
CH
Saade
George
G
Berkowitz
Richard
R
Klugman
Susan
S
Dugoff
Lorraine
L
Craigo
Sabrina D
SD
Timor-Tritsch
Ilan
I
Carr
Stephen R
SR
Wolfe
Honor M
HM
Bianchi
Diana W
DW
D'Alton
Mary E
ME
D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D046689:Fetal Mortality; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology