Prepregnancy obesity and the racial disparity in infant mortality

Abstract

Objectives To estimate the extent to which prepregnancy obesity explains the Black-White disparity in stillbirth and infant mortality. Methods A population-based study of linked Pennsylvania birth-infant death certificates (2003-2011; n=1,055,359 births) and fetal death certificates (2006-2011; n=3,102 stillbirths) for all singleton pregnancies in non-Hispanic (NH) White and NH Black women. Inverse probability weighted regression was used to estimate the role of prepregnancy obesity in explaining the race-infant/fetal death association. Results Compared with NH White women, NH Black women were more likely to be obese (≥30kg/m2) and experienced a higher rate of stillbirth (8.3 vs. 3.6 stillbirths per 1,000 liveborn and stillborn infants) and infant death (8.5 vs. 3.0 infant deaths per 1,000 livebirths). When the contribution of prepregnancy obesity was removed, the difference in risk between NH Blacks and NH Whites decreased from 6.2 (95% CI: 5.6, 6.7) to 5.5 (95% CI: 4.9, 6.2) excess stillbirths per 1,000 and 5.8 (95% CI: 5.3, 6.3) to 5.2 (95% CI: 4.7, 5.7) excess infant deaths per 1,000. Conclusions For every 10,000 livebirths in Pennsylvania (2003 to 2011), six of the 61 excess infant deaths in NH Black women and 5 of the 44 excess stillbirths (2006-2011) were attributable to prepregnancy obesity.

Mediation analysis for estimating cardioprotection of longitudinal RAS inhibition beyond lowering blood pressure and albuminuria in type 1 diabetes

“…Confidence intervals were obtained using robust variance estimators, which account for pseudo-clustering induced by the inverse probability weights (38). Finally, the mediation proportion of blood pressure or albuminuria in the RAS inhibition -CAD association was calculated as the absolute value of: ([Total effect -Controlled Direct Effect] / Total effect) × 100% (31,41).…”

Comparison of Parametric and Nonparametric Estimators for the Association Between Incident Prepregnancy Obesity and Stillbirth in a Population-Based Cohort Study

“…Details on data collection methods have previously been published (28). Briefly, medical records were used for information on maternal characteristics, parity, delivery payment method, prepregnancy diabetes or hypertension, address of the primary residence, gestational age at delivery, and level of neonatal care available at the birth facility.…”

Race, obesity, and birth outcomes: Unraveling a complex association to improve maternal‐child health

“…A study by Lemon et al in this issue of Obesity considers the convergence of these two issues: how racial disparities in maternal obesity contribute to persistent racial disparities in stillbirth and infant death. (1)…”

“…(4, 5, 6, 7) The study estimated that approximately 10% of the black/white racial disparity in stillbirth and infant death is attributable to the higher prevalence of obesity in African-American women. (1)…”