Variations in gestational length and preterm delivery by race, ethnicity and migration

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 32; pp. 60 - 68
• Main Authors: Sørbye, Ingvil K., PhD, MD, Wanigaratne, Susitha, PhD, Urquia, Marcelo L., PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2016
• Subjects: Continental Population Groups; Developed Countries; Developing Countries; Emigrants and Immigrants; Ethnic Groups; ethnicity; Europe - epidemiology; Female; Gestational Age; gestational length; Health Status Disparities; Healthcare Disparities - ethnology; Humans; Infant, Newborn; migration; Minority Groups; Obstetrics and Gynecology; Pregnancy; Premature Birth - ethnology; preterm delivery; race; Risk Factors; Socioeconomic Factors; migration; race; ethnicity; gestational length; preterm delivery; minority groups
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2015.08.017

Preterm delivery rates within industrialized countries have been reported to vary according to the parents' race, ethnicity and migrant status; however, such disparities are poorly understood. In this paper, the available evidence and potential clinical significance of racial/ethnic and migrant disparities in gestational length and preterm delivery are assessed alongside potential explanatory factors. Although measurement bias in gestational length has the potential to inflate disparities, there is a consistently higher risk of preterm birth among some racial/ethnic groups. These differences most likely reflect lasting socio-economic disadvantage and discrimination rather than genetic mechanisms. The effect of migrant status is less conclusive due to heterogeneity of populations and the healthy migrant effect; however, environmental influences in the receiving country are implicated in driving increases of overall preterm rates. When assessing preterm delivery rates across ethnic and migrant groups, the use of standardized, ultrasound-based pregnancy dating methods is crucial to minimize bias. Current evidence does not justify the provision of a different clinical care approach to minority or immigrant women solely based on their race, ethnicity or country of origin; however, these labels may serve as flags for further inquiry on individual risk factors and a detailed obstetric history.