Decreased preterm births in an inner-city public hospital.
OBJECTIVE
To examine preterm births among African-American and Hispanic women who delivered at an inner-city public hospital in the context of contemporaneously increasing rates in the United States.


METHODS
The rates of preterm birth, defined as birth before 37 weeks of gestation, for singleton neonates with birth weights of 500 g or higher delivered to women who had prenatal care at Parkland Hospital between 1988 and 2006 were compared with similar births in the United States from 1995 to 2002. Preterm birth rates also were compared for white, African-American, and Hispanic women as were disparity in these rates using white women as the referent.


RESULTS
The Parkland Memorial Hospital cohort included 260,197 women, of whom 70% were Hispanic, 20% African-American, and 8% white. The U.S. cohort included 29,366,816 women, of whom 61% were white, 19% Hispanic, and 14% African-American. Between 1995 and 2002, the rate of preterm birth in the United States increased from 9.4% to 10.1% (P<.001). Between 1988 and 2006, the rate of preterm births at Parkland decreased from 10.4% to 4.9% (P<.001). Moreover, the rates of preterm birth were significantly lower in Hispanic and African-American women who delivered at Parkland compared with the same ethnicity/race groups in the U.S. cohort. The decline in preterm births at Parkland Memorial Hospital coincided with increased prenatal care use.


CONCLUSIONS
Preterm birth significantly decreased in minority women delivered at an inner-city public hospital. We hypothesize that the reduction in preterm births was the result of a public health care program specifically targeting minority pregnant women.
Leveno
Kenneth J
KJ
From the University of Texas Southwestern Medical Center, and the Department of Obstetrics and Gynecology, Parkland Health and Hospital System, Dallas, Texas.
McIntire
Donald D
DD
Bloom
Steven L
SL
Sibley
Miriam R
MR
Anderson
Ron J
RJ
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D047928:Premature Birth / Q000453:epidemiology* / Q000208:ethnology; D011295:Prenatal Care / Q000706:statistics & numerical data; D011634:Public Health; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*