title: Risk of miscarriage among black women and white women in a U.S. Prospective Cohort Study.
abstract: Many adverse pregnancy outcomes differ by race. We examined the association between self-reported race and miscarriage (pregnancy loss at <20 weeks) in a community-based pregnancy cohort. Women from the southeastern United States (North Carolina, Texas, and Tennessee) were enrolled in "Right from the Start" from 2000 to 2009. They were recruited while trying to conceive or during early pregnancy. Participants completed study ultrasound examinations, interviews, and consent forms for review of medical records. We used proportional hazard models to examine miscarriage risk among black women compared with white women, adjusted for confounders. There were 537 observed miscarriages among 4,070 women, 23% of whom self-identified as black (n = 932). The life table-adjusted cumulative risk of loss after gestational week 5 was 21.3%. With adjustment for age and alcohol use, blacks had increased risk of miscarriage compared with whites (adjusted hazard ratio = 1.57, 95% confidence interval: 1.27, 1.93). When risk of loss before gestational week 10 was dichotomized at the median gestational age, there was little difference, but black women had a greater risk thereafter compared with white women (adjusted hazard ratio = 1.93, 95% confidence interval: 1.48, 2.51). Early pregnancy ultrasound examinations did not differ by race. In summary, self-reported race is independently associated with risk of miscarriage, and the higher risk for black women is concentrated in gestational weeks 10-20.
authors.affiliation: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, 2525West End Avenue, Suite 600, Nashville, TN 37203-1739, USA.
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Digna R
authors.initials: DR
authors.lastname: Velez Edwards
authors.forename: Donna D
authors.initials: DD
authors.lastname: Baird
authors.forename: David A
authors.initials: DA
authors.lastname: Savitz
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Hartmann
mesh_terms: D000022:Abortion, Spontaneous / Q000208:ethnology*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: disparity; miscarriage; pregnancy; prospective cohort; race; reproductive epidemiology
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