The causes of racial disparity in preterm birth (PTB) rate are poorly understood. Cervical insufficiency (CI) is one contributor to PTB. Our objective was to examine racial/ethnic differences in CI risk.METHODS:
We conducted a retrospective cohort study of singleton pregnant women in Kaiser Permanente Northern California (KPNC) in 2012. Primary outcome was CI and secondary outcomes included stillbirth, PTB, and neonatal intensive care unit (NICU) admission. We compared rates of these outcomes among women of different racial/ethnic background. Multivariable logistic regression modeling was used to assess other potential risk factors for CI, including maternal age, parity, medical comorbidities, prior cervical procedures, prior pregnancy terminations, and history of PTB.RESULTS:
A total of 34,173 women were included in the study. The racial/ethnic makeup of the cohort was 38.6% White, 25.8% Asian, 25.1% Hispanic, 7% African-American, and 3.5% other/unknown. Approximately 1% (401) were diagnosed with CI. African-American women had a higher rate of CI (3.2%) compared to other groups (0.9–1.2%). African-American women also had higher rates of PTB (9.2%) and their infants had higher rates of NICU care (8.7%) compared to other racial/ethnic groups. Regression analysis showed that African-American race/ethnicity was significantly associated with CI compared to White race/ethnicity (OR 2.89) after controlling for other variables associated with CI.CONCLUSION:
In our cohort, African-American women had higher odds of CI compared to White women. This disparity may contribute in part to the significantly higher rate of PTB among African-American women.