Of the 4 million babies born each year in the United States, one out of eight will be premature. According to medical studies, the greatest risk factors for preterm labor are a previous history of preterm delivery and African American ethnicity. Yes, African American women carry the greatest risk, followed by Hispanics and both women are usually caught off guard. There is a 16-18 percent risk of African American women delivering early as opposed to a 7 percent risk for Caucasian women. According to CDC, in 2007, one of every five infants born to non-Hispanic black mothers was born preterm, compared with one of every eight to nine births to Non-Hispanic and Hispanic women. In the same year, the preterm birth rate of non-Hispanic black infants was 59% higher than the rate for non-Hispanic white infants (11.5%) and 49% higher than the rate for Hispanic infants (12.3%). Premature babies face multiple challenges—including cerebral palsy and other physical and intellectual disabilities—and many die within the first year of life. This public health crisis costs $26 billion annually for the care of premature babies in neonatal intensive care units.
Why is this important? Preterm babies are more likely to have long-term health problems, such as developmental disabilities. One in five preterm children are born with mental retardation, one in three with visual impairment, and almost half of these babies are born with cerebral palsy. These babies are also at an increased risk of developing heart problems and diabetes as adults. Minority women are less likely than others to receive maternal corticosteroids. The use of steroids is extremely important because it promotes lung maturity. Medical studies have documented that African American women were one-third likely and Latino women nearly 100 percent less likely to receive steroid therapy than were other women in similar clinical situations.
Preterm labor is a public health crisis because it is responsible for 75 percent of infant deaths and 50 percent of the cases of physically challenged children. The healthcare disparity of preterm babies places minority women and children at greater risk for adverse outcomes including death. Why are there disparities? There is no one answer but multifactorial reasons that include: socioeconomic status, prenatal care, maternal risk behaviors, infection, nutrition, stress and genetics. Cultural competence of healthcare providers and physicians would certainly be a good place to start with respect to reducing disparities. The engagement of patients as co-partners with respect to their pregnancies would help as well. Patients need to be made aware that:
1. They should seek early prenatal care if they had a previous premature baby
2. Make sure their cervix is measured after 14 weeks. The shorter the cervix, the greater the risk of a premature delivery.
3. Ask for steroids to improve the maturity of the baby’s lungs if premature labor cannot be stopped.
4. Know the signs of preterm labor such as back pain, pressure or abdominal pain that lasts for greater than one hour
5. Be tested for sexually transmitted infections
Preterm healthcare disparities can be reduced. The question is whether our healthcare system along with its providers are willing to do the work.