Washington, DC -- Although access to prenatal care in the US has increased in recent years, minorities continue to experience disproportionately high rates of miscarriage and newborn mortality, according to new research published in the March issue of Obstetrics & Gynecology. The study suggests that the problem stems from a prenatal care system that does not adequately address racial and ethnic disparities in women's health.

The study was comprised of 35,529 pregnant women (5% black, 22% Hispanic, 68% white, 5% other) with access to early prenatal care. All participants were enrolled in the First- and Second-Trimester Evaluation of Risk (FASTER) trial between 1999 and 2002. Researchers monitored perinatal loss at three intervals — less than 24 weeks of gestation, 24 or more weeks of gestation, and newborn death.

Overall, 1.3% of pregnancies ended in miscarriage or newborn death. All minorities experienced significantly higher perinatal mortality than whites, with blacks having the highest rate. For every 1,000 pregnancies, there were 42.1 perinatal losses for blacks, 16.6 for those classified as "other," 15.9 for Hispanics, and 10 for whites. While blacks comprised only 5% of the study sample, they accounted for 16% of the perinatal mortalities.

Minority women had an increased incidence of preexisting health conditions such as diabetes, hypertension, and being overweight, and had higher rates of smoking. Additionally, minorities were more likely to experience pregnancy complications such as preterm premature rupture of the membranes, preeclampsia, gestational diabetes, preterm birth, and cesarean delivery. Racial disparities in perinatal mortality remained even after controlling for these factors.

The benefits of regularly scheduled prenatal care visits are well-documented. However, this study demonstrates that increased accessibility to early prenatal care has not had as positive an effect on minority communities as expected. The authors suggest developing and incorporating new prenatal care strategies for minority women to help lower perinatal mortality.

Contact: Andrew J. Healy, MD, Columbia University Medical Center, New York, NY, at ajh2102@columbia.edu

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