Why Is the U.S. Preterm Birth Rate So Much Higher Than the Rates in Canada, Great Britain, and Western Europe?

Abstract

The portion of newborns delivered before term is considerably higher in the United States than in other developed countries. We compare the array of risk exposures and protective factors common to women across national settings, using national, regional, and international databases, review articles, and research reports. We find that U.S. women have higher rates of obesity, heart disease, and poor health status than women in other countries. This is in part because more U.S. women are exposed to the stresses of racism and income disparity than women in other national settings, and stress loads are known to disrupt physiological functions. Pregnant women in the United States are not at higher risk for preterm birth because of older maternal age or engagement in high-risk behaviors. However, to a greater extent than in other national settings, they are younger and their pregnancies are unintended. Higher rates of multiple gestation pregnancies, possibly related to assisted reproduction, are also a factor in higher preterm birth rates. Reproductive policies that support intentional childbearing and social welfare policies that reduce the stress of income insecurity can be modeled from those in place in other national settings to address at least some of the elevated U.S. preterm birth rate.

Is preterm birth associated with intimate partner violence and maternal malnutrition during pregnancy in Ethiopia? A systematic review and meta analysis

“…The fact that the results are comparable to estimates from North America reflects the high prevalence of chronic disease in the latter– namely obesity, heart disease, and multiple gestations possibly related to assisted reproduction and unintended pregnancies. Women are exposed to stress loads that are known to disrupt physiological functions and are a known risk factor in the increase of preterm labor despite having an improved healthcare system than that of Ethiopia [ 70 ]. This pooled estimate was higher compared with the national prevalence of South Korea in which 7.1% [ 71 ] of live births were preterm.…”

Stretch Causes Cell Stress and the Downregulation of Nrf2 in Primary Amnion Cells

“…Additionally, socioeconomic impacts of social isolation and financial burden have also been identified as negative outcomes of PTB [ 4 ]. The United States faces significant racial and ethnic disparities in PTB, whilst also having PTB rates much higher than other developed countries [ 1 , 5 ]. While PTB’s etiology is complex, infection leads to almost 50% of preterm deliveries [ 6 ].…”

The Political Context and Infant Health in the United States

“…The macro-comparative approach has also been criticized for ignoring heterogeneity in the consequences of political factors across national populations (Beckfield and Krieger 2009; Pega et al 2013). This critique is particularly relevant for the United States, where despite relatively high per capita income and health spending, infant health remains worse than in other wealthy countries, partly because of wide racial and economic disparities, with African American and low-income infants experiencing particularly poor birth outcomes (Bronstein, Wingate, and Brisendine 2018; Chen et al 2016; Ciciolla, Addante, and Huffer 2020). Understanding the effect of political context on infant health requires, therefore, considering critical axes of heterogeneity within the population.…”