Racial differences in prenatal care of mothers delivering very low birth weight infants

Paul, David A.; Locke, Robert; Zook, Katie; Leef, Kathleen H; Stefano, John L.; Colmorgen, Garrett H. C.

doi:10.1038/sj.jp.7211428

Cited by 21 publications

(9 citation statements)

References 24 publications

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“…It has been shown that non-white populations have decreased access to, and utilization of, prenatal care. 12-15 It is thus plausible that a higher proportion of non-white patients who presented postnatally might, had they had received equivalent prenatal care compared to the white population, have been diagnosed prenatally,. This hypothesis is supported by the fact that the proportion of older children (>12 years) among whites was nearly double that among nonwhites (15% vs. 9%), which would be expected if more “missed” nonwhites present early in childhood.…”

Section: Discussionmentioning

confidence: 99%

Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

et al. 2011

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Purpose We have previously shown that non-white patients with UPJ obstruction undergo pyeloplasty at a younger age than do whites. The mechanisms behind this are unclear, as there is no known racial variation in the natural history of UPJ obstruction. We sought to use a detailed clinical database to explain this phenomenon. Methods We performed a retrospective review of all patients undergoing primary pyeloplasty at our institution between 1992 and 2008. Over 360 data points were abstracted for each patient, including self-reported patient race, socioeconomic status, symptom duration, and presentation. Results Of 847 patients undergoing pyeloplasty during the study period, 741 met inclusion criteria. Non-white patients underwent surgery younger than did whites (non-white 0.6 v. white 2.6 years, p<0.0001). When stratified by timing of clinical presentation (prenatal versus postnatal), there was no significant difference by race among patients presenting prenatally (0.37 v. 0.36 years, p=0.22). Non-white patients presenting postnatally were significantly younger than white patients (6.3 v. 8.2 years, p=0.03). This appeared to be due to differences in both the age at initial clinical presentation (5.4 v. 7.0 years, p=0.03) and in time from initial clinical presentation to urology evaluation (0.6 v. 3.2 months, p=0.03). These differences persisted after correcting for other factors, including markers of socioeconomic status. Conclusions Consistent with previous studies, we found that non-white patients underwent primary pyeloplasty at a younger age than whites. This difference is limited to patients presenting after birth. Prenatally diagnosed patients underwent surgery at similar ages regardless of race.

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Section: Discussionmentioning

confidence: 99%

Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

et al. 2011

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“…42 Of particular salience to the topic at hand, African American pregnant women are less likely to receive medical advice, information about health risks and complications, 43 and common prenatal treatments, such as tocolytics and antenatal steroids. 44 A landmark study conducted by the Institute of Medicine (IOM) finds that even at comparable levels of access, racial/ethnic minorities receive less intensive and poorer quality health care services than do whites. 45 Racial differences in patient preferences and care-seeking behaviors do not explain these inequities in treatment.…”

Section: Persistent Racial Disparities In Adverse Birth Outcomesmentioning

confidence: 99%

Race, Racism, and Racial Disparities in Adverse Birth Outcomes

Dominguez

2008

Clinical Obstetrics &Amp; Gynecology

144

101

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While the biologic authenticity of race remains a contentious issue, the social significance of race is indisputable. The chronic stress of racism and the social inequality it engenders may be underlying social determinants of persistent racial disparities in health, including infant mortality, preterm delivery, and low birth weight. This article describes the problem of racial disparities in adverse birth outcomes; outlines the multidimensional nature of racism and the pathways by which it may adversely affect health; and discusses the implications for clinical practice.

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“…It has been shown that Black women are less likely to get clinical advice and support to decrease smoking and alcohol use during pregnancy (Kogan et al, 1994). Additionally, Black women are less likely to receive antenatal steroids, tocolytic medications, and are more likely to have a birth by cesarean section (Paul et al, 2006). More specifically, whether or not women of color seek care and what factors impact those decisions are distinct from understanding their experiences of their healthcare encounters, which has been shown to impact patients' perceptions of the quality of the care they receive (Dehlendorf et al, 2016;Thornton et al, 2011).…”

Section: Background and Significancementioning

confidence: 99%

Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth

McLemore¹,

Altman²,

Cooper

et al. 2018

Social Science & Medicine

257

251

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Background: Chronic stress is a known risk factor for preterm birth, yet little is known about how healthcare experiences add to or mitigate perceived stress. In this study, we described the pregnancy-related healthcare experiences of 54 women of color from Fresno, Oakland, and San Francisco, California, with social and/or medical risk factors for preterm birth. Methods: This study was a secondary analysis of focus group data generated as part of a larger project focused on patient and community involvement in preterm birth research. English and Spanish speaking women, age 18 or greater with social and/or medical risk factors for preterm birth participated in two focus groups, six weeks apart. Data from the first focus groups are included in this analysis. Results: Five themes emerged from thematic analysis of the transcripts. Participants described disrespect during healthcare encounters, including experiences of racism and discrimination; stressful interactions with all levels of staff; unmet information needs; and inconsistent social support. Despite these adverse experiences, women felt confidence in parenting and newborn care. Participant recommendations for healthcare systems improvement included: greater attention to birth plans, better communication among multiple healthcare providers, more careful listening to patients during clinical encounters, increased support for social programs such as California's Black Infant Health, and less reliance on past carceral history and/or child protective services involvement. Discussion: The women in this study perceived their prenatal healthcare as a largely disrespectful and stressful experience. Our findings add to the growing literature that women of color experience discrimination, racism and disrespect in healthcare encounters and that they believe this affects their health and that of their infants.

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Racial differences in prenatal care of mothers delivering very low birth weight infants

Cited by 21 publications

References 24 publications

Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

Racial Variation in Timing of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

Race, Racism, and Racial Disparities in Adverse Birth Outcomes

Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth

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