Maternal Race, Demography, and Health Care Disparities Impact Risk for Intraventricular Hemorrhage in Preterm Neonates

Abstract

Objective To determine whether risk factors associated with Grade (Gr) 2–4 intraventricular hemorrhage (IVH) differs between African ancestry and white subjects. Study design Inborn, appropriate for gestational age (GA) infants with birth weights (BW) 500–1250 grams and exposed to >1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had Gr 2–4 IVH and controls matched for site, race and BW range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race. Results Subjects included 579 African ancestry or white race infants with Gr 2–4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have > 1 prenatal visit and have a multiple gestation (P ≤.01 for all). Increasing GA (P =.01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001) and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), Apgar< 3 at 5 min (P < .004), surfactant (P < .001) and high frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having >1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001) and higher maternal education with decreased IVH risk (P < .05). Conclusion Risk for IVH differs between African ancestry and white infants and may be attributable to both race and health care disparities.

Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids

“…Whether this relates to the racial differences noted in incidence of ICH remains to be determined. 22 …”

Racial/ethnic differences in preterm perinatal outcomes

“…15 In an analysis limited to preterm deliveries similar to the current study, increased incidence of IVH among Blacks was attenuated among women with at least one prenatal visit, implicating racially-differential health care access and utilization. 16 An older study examined the causes and factors of developing PVH/IVH in premature infants and reported that mothers with pregnancy-induced hypertension were less likely to have neonates with PVH/IVH, likely attributable to medication use or obstetrical management. 17 Gestational hypertension most commonly complicated pregnancies among White women in our data and risk for IVH was lower in this group.…”

Genes and environment in neonatal intraventricular hemorrhage

“…15 Lower GA and birth weight (BW), male gender, white race, chorioamnionitis, Apgar < 3 at 5 minutes, delivery room resuscitation, surfactant administration, neonatal transport, illness severity, assisted ventilation, disturbances of partial pressure of CO 2 , respiratory distress syndrome and high frequency ventilation have all been reported to increase risk for IVH, while a complete course of ANS, cesarean delivery and preeclampsia decrease the risk for IVH (for review please see Shankaran 29 ).…”

“…30–32 Further, infants of African ancestry mothers are less likely to receive surfactant or assisted ventilation, 33 and IVH-related mortality is two times higher in African ancestry neonates when compared to white preterm infants. 34 A recent large prospective analysis demonstrated that white race decreased risk for grades 2–4 IVH in preterm neonates of 500–1250 g; 29 notably, among white infants but not black neonates, multiple gestation was associated with increased risk of IVH, while higher maternal education was associated with a decreased incidence of hemorrhage. When compared to white neonates, infants of African ancestry less often received ANS exposure and required more vigorous delivery room resuscitation.…”