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162: Racial disparities in preterm birth rates among women with history-indicated cerclages

      Objective

      To determine if there is a difference in gestational age at delivery between African-American and Caucasian women who have undergone a history indicated cervical cerclage.

      Study Design

      This was an IRB approved, retrospective cohort study of African-American and Caucasian women who underwent a history-indicated cervical cerclage. The study subjects were identified from a validated, research quality perinatal database. All subjects received a history indicated vaginal cerclage utilizing a McDonald technique prior to 15 weeks of gestation. The primary outcome was spontaneous preterm birth; subdivided by gestational age as less than 20 weeks, 20-23 weeks, 24-27 weeks, 28-31 weeks, 32-34 weeks and 35-36 weeks. Cumulative incidence of preterm birth was reported. Multivariable logistic regression was used to control for demographic and clinical differences between groups.

      Results

      A cohort of 270 women was identified from between 1997 and 2007; 198 African-American women (study group) and 72 Caucasian women (control group). African-American women were significantly more likely to be obese (p<.0001), have Medicaid insurance (p<.01), and be diagnosed with bacterial vaginosis (p<.05) or Chlamydia cervicitis (p<.05). Caucasian women were significantly more likely to have had a previous cesarean section (p<.002). There was no difference in the odds of delivery prior to 20 weeks of gestation between cohorts. The African-American women were at significantly increased risk of delivery prior to 24 weeks (8.6 % vs. 1.4% adj OR 5.39 [1.05 – 17.3]), 28 weeks (20.2% vs. 4.2% adj OR 5.683 [1.1-18.3]) and 32 weeks of gestation (35.4% vs. 15.3% adj OR 3.05 [1.57-8.4]) compared to the Caucasian women. The mean gestational age (32.7 vs. 34.5 weeks) and birth weight (2209 vs.2608 grams, p<.01) were also significantly lower for the African-American women.

      Conclusion

      African-American women undergoing history indicated cerclages experienced significantly higher rates of preterm birth less than 24, 28 and 32 weeks of gestation when compared to Caucasian women.