Impact of Paternal Race and Educational Status on Pregnancy Outcome among Paternity Acknowledged Births in the United States

Abstract

Introduction: Several studies have explored the role of maternal parameters on pregnancy outcome; however, very few studies have examined the interaction between paternal race/ethnicity and educational status. Aim: To determine the interaction between paternal race/ethnicity and educational level and how this interaction influences pregnancy outcome among paternity acknowledged births in the USA. Methods: We utilized the US Vital Statistics records to collate paternal characteristics of paternally acknowledged births between 2015-2019. We conducted a multivariate analysis with an interaction term to determine the interaction between paternal race and education. We then ascertained how the interaction influences pregnancy outcomes across eight outcome measures. These outcome measures included infant mortality, breastfeeding, 5 min Apgar score, neonatal unit admission, neonates receiving assisted ventilation > 6 hours following delivery, cesarean section, mothers requiring blood transfusion, and admission to the intensive care unit. Results: There were a total of 4 555,334 paternity acknowledged pregnancies in the study period. About 23% of the women declined to breastfeed after delivery. Across all races/ethnicities, there was a significant association between paternal education, increased cesarean section rate, and increased uptake of breastfeeding. Having a Hispanic father was associated with the highest odds of breastfeeding (OR=1.78; 95% CI 1.76-1.79). Despite having a higher risk of NICU admission, Poor 5min- Apgar score, and assisted ventilation, there was no difference in neonatal mortality rate between White fathers and any other race/ethnicities. Conclusions: Paternal race and educational status significantly impact pregnancy outcomes among paternity acknowledged births in the United States. The study highlights the importance of including paternal parameters in algorithms designed to improve pregnancy outcomes.