Maternal Racial and Ethnic Disparities in Neonatal Birth Outcomes With and Without Assisted Reproduction

Abstract

OBJECTIVE To explore disparities in prematurity and low birth weight (LBW) by maternal race and ethnicity among singletons conceived with and without assisted reproductive technology (ART). METHODS We performed a retrospective cohort study using resident birth certificate data from Florida, Massachusetts, and Michigan linked with data from the National ART Surveillance System from 2000 to 2010. There were 4,568,822 live births, of which 64,834 were conceived with ART. We compared maternal and ART cycle characteristics of singleton liveborn neonates using χ2 tests across maternal race and ethnicity groups. We used log binomial models to explore associations between maternal race and ethnicity and LBW and preterm birth by ART conception status. RESULTS The proportion of liveborn neonates conceived with ART differed by maternal race and ethnicity (P<.01). It was smallest among neonates of non-Hispanic black (0.3%) and Hispanic women (0.6%) as compared with neonates of non-Hispanic white (2.0%) and Asian or Pacific Islander women (1.9%). The percentages of LBW or preterm singletons were highest for neonates of non-Hispanic black women both for non-ART (11.3% and 12.4%) and ART (16.1% and 19.1%) -conceived neonates. After adjusting for maternal factors, the risks of LBW or preterm birth for singletons born to non-Hispanic black mothers were 2.12 [95% confidence interval (CI) 2.10–2.14] and 1.56 (95% CI 1.54–1.57) times higher for non-ART neonates and 1.87 (95% CI 1.57–2.23) and 1.56 (95% CI 1.34–1.83) times higher for ART neonates compared with neonates of non-Hispanic white women. The adjusted risk for LBW was also significantly higher for ART and non-ART singletons born to Hispanic (adjusted relative risk [RR] 1.26, 95% CI 1.09–1.47 and adjusted RR 1.15, 95% CI 1.13–1.16) and Asian or Pacific Islander (adjusted RR 1.39, 95% CI 1.16–1.65 and adjusted RR 1.55, 95% CI 1.52–1.58) women compared with non-Hispanic white women. CONCLUSION Disparities in adverse perinatal outcomes by maternal race and ethnicity persisted for neonates conceived with and without ART.

Sociodemographic patterning in the oral microbiome of a diverse sample of New Yorkers

“…3 1 Highlights 2  Most microbiome studies to date have had minimal sociodemographic variability, 3 limiting what is known about associations of social factors and the microbiome. 4  We examined the oral microbiome in a population-based sample of New Yorkers with 5 wide sociodemographic variation. 6  Numerous taxa were differentially abundant by race/ethnicity, income, education, 7 marital status, and nativity.…”

“…10  Mediation of health disparities by microbial factors may represent an important 11 intervention site to reduce health disparities, and should be explored in prospective 12 studies . 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 4 1 2 Introduction 2 3 Health disparities by race/ethnicity, socioeconomic status (SES), sex, and other 4 sociodemographic factors have long been observed but their mechanisms have yet to be fully 5 elucidated. In particular, racial/ethnic and socioeconomic disparities have been consistently 6 observed in oral health outcomes (1), cardiovascular disease (CVD) (2,3), diabetes (4), preterm 7 birth and low birth weight (5,6), and rheumatoid arthritis (7).…”

“…113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 4 1 2 Introduction 2 3 Health disparities by race/ethnicity, socioeconomic status (SES), sex, and other 4 sociodemographic factors have long been observed but their mechanisms have yet to be fully 5 elucidated. In particular, racial/ethnic and socioeconomic disparities have been consistently 6 observed in oral health outcomes (1), cardiovascular disease (CVD) (2,3), diabetes (4), preterm 7 birth and low birth weight (5,6), and rheumatoid arthritis (7). 8 9 Variations in human oral microbiome structure and function have been associated with oral 10 disease (8,9), as well as a wide range of systemic illnesses including CVD (10)(11)(12), diabetes (13, 11 14), cancers (15)(16)(17)(18), birth outcomes (19,20), and rheumatoid arthritis (21,22).…”

“…Briefly, we selected the 90 self-reported current cigarette smokers with the 30 highest serum cotinine, 45 randomly selected never smokers with serum cotinine <0.05 ng/mL, 31 45 randomly selected former smokers with serum cotinine <0.05 ng/mL, all 38 former and 32 never smokers with serum cotinine between 1 and 14 ng/mL, and 79 participants reporting 4 Participants were asked to fast for 9 hours prior to oral rinse collection. A 20-second oral rinse 5 was divided into two 5-second swish and 5-second gargle sessions using 15 mLs of Scope® 6 mouthwash. After each session, participants expectorated the rinse into a sterile cup.…”

“…281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 7 1 Before edgeR, we filtered out OTUs that did not have three or more samples with a count of at 2 least eight, leaving 216 OTUs for analysis, a filter representing an approximate inflection point 3 on the curve of remaining OTUs against the minimum count. To examine potential mediators, 4 we fit crude models as well as models adjusted for oral health behaviors, diet, smoking status, 5 and age and sex (when applicable). edgeR was conducted at the taxonomic level of highest 6 specificity allowed, which was the genus in all cases where FDR was less than 1%; therefore 7 differential abundance findings are presented at the genus level.…”