title: Early access to prenatal care: implications for racial disparity in perinatal mortality.
abstract: 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.
authors.affiliation: Columbia University Medical Center, 622 West 168th Street, PH-16, New York, NY 10032, USA. ajh2102@columbia.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Healy
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: T Flint
authors.initials: TF
authors.lastname: Porter
authors.forename: David A
authors.initials: DA
authors.lastname: Luthy
authors.forename: Christine H
authors.initials: CH
authors.lastname: Comstock
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Richard
authors.initials: R
authors.lastname: Berkowitz
authors.forename: Susan
authors.initials: S
authors.lastname: Klugman
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dugoff
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Craigo
authors.forename: Ilan
authors.initials: I
authors.lastname: Timor-Tritsch
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.forename: Honor M
authors.initials: HM
authors.lastname: Wolfe
authors.forename: Diana W
authors.initials: DW
authors.lastname: Bianchi
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
mesh_terms: 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