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. 2004 Jul;96(7):987–994.

Generations of loss: contemporary perspectives on black infant mortality.

Adrienne J Headley 1
PMCID: PMC2568419  PMID: 15253333

Abstract

The U.S. black infant mortality rate (IMR) remains a significant public health concern. Although improved during the last four decades, the U.S. IMR remains within the lowest tier of IMRs for all industrialized countries, and black American infants remain disproportionately represented in low birthweight (LBW) and infant death statistics. Numerous risk factors have been analyzed for their relative contributions to the U.S. IMR and black-white infant survival health disparities. Those factors include prenatal care quality and access, maternal socioeconomic status (SES), HIV/AIDS status, infections, intrapartum risk factors, existing comorbidities, social support, and nutritional status. However, the role of these and other factors have not fully explained the higher infant mortality risks for black infants. This review will discuss a variety of risk factors that contribute to infant mortality disparities between non-Hispanic black and white infants. Among those factors, the goal will be to review selected topics pertaining to maternal SES, LBW, preterm birth, perinatology advances, birth record data quality, maternal stress, prenatal care adequacy, and physical and substance abuse, and the relationships of those topics to black-white IMR health disparities.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander G. R., Allen M. C. Conceptualization, measurement, and use of gestational age. I. Clinical and public health practice. J Perinatol. 1996 Jan-Feb;16(1):53–59. [PubMed] [Google Scholar]
  2. Alexander G. R., Hulsey T. C., Robillard P. Y., De Caunes F., Papiernik E. Determinants of meconium-stained amniotic fluid in term pregnancies. J Perinatol. 1994 Jul-Aug;14(4):259–263. [PubMed] [Google Scholar]
  3. Alexander G. R., Kogan M. D., Himes J. H., Mor J. M., Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatr Perinat Epidemiol. 1999 Apr;13(2):205–217. doi: 10.1046/j.1365-3016.1999.00174.x. [DOI] [PubMed] [Google Scholar]
  4. Alexander G. R., Tompkins M. E., Cornely D. A. Gestational age reporting and preterm delivery. Public Health Rep. 1990 May-Jun;105(3):267–275. [PMC free article] [PubMed] [Google Scholar]
  5. Alexander G. R., Tompkins M. E., Petersen D. J., Weiss J. Source of bias in prenatal care utilization indices: implications for evaluating the Medicaid expansion. Am J Public Health. 1991 Aug;81(8):1013–1016. doi: 10.2105/ajph.81.8.1013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Allen M. C., Alexander G. R., Tompkins M. E., Hulsey T. C. Racial differences in temporal changes in newborn viability and survival by gestational age. Paediatr Perinat Epidemiol. 2000 Apr;14(2):152–158. doi: 10.1046/j.1365-3016.2000.00255.x. [DOI] [PubMed] [Google Scholar]
  7. Allen M. C., Alexander G. R., Tompkins M. E., Hulsey T. C. Racial differences in temporal changes in newborn viability and survival by gestational age. Paediatr Perinat Epidemiol. 2000 Apr;14(2):152–158. doi: 10.1046/j.1365-3016.2000.00255.x. [DOI] [PubMed] [Google Scholar]
  8. Bakketeig L. S., Jacobsen G., Hoffman H. J., Lindmark G., Bergsjø P., Molne K., Rødsten J. Pre-pregnancy risk factors of small-for-gestational age births among parous women in Scandinavia. Acta Obstet Gynecol Scand. 1993 May;72(4):273–279. doi: 10.3109/00016349309068037. [DOI] [PubMed] [Google Scholar]
  9. Brett Kate M., Schoendorf Kenneth C., Kiely John L. Differences between black and white women in the use of prenatal care technologies. Am J Obstet Gynecol. 1994 Jan;170(1 Pt 1):41–46. doi: 10.1016/s0002-9378(94)70381-7. [DOI] [PubMed] [Google Scholar]
  10. Chasnoff I. J. Cocaine and pregnancy: clinical and methodologic issues. Clin Perinatol. 1991 Mar;18(1):113–123. [PubMed] [Google Scholar]
  11. Chomitz V. R., Cheung L. W., Lieberman E. The role of lifestyle in preventing low birth weight. Future Child. 1995 Spring;5(1):121–138. [PubMed] [Google Scholar]
  12. Clarke L. L., Miller M. K., Vogel W. B., Davis K. E., Mahan C. S. The effectiveness of Florida's "Improved Pregnancy Outcome" program. J Health Care Poor Underserved. 1993;4(2):117–132. doi: 10.1353/hpu.2010.0445. [DOI] [PubMed] [Google Scholar]
  13. Cohen S., Kamarck T., Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385–396. [PubMed] [Google Scholar]
  14. Collins J. W., Jr, Butler A. G. Racial differences in the prevalence of small-for-dates infants among college-educated women. Epidemiology. 1997 May;8(3):315–317. doi: 10.1097/00001648-199705000-00015. [DOI] [PubMed] [Google Scholar]
  15. David R. J., Collins J. W., Jr Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med. 1997 Oct 23;337(17):1209–1214. doi: 10.1056/NEJM199710233371706. [DOI] [PubMed] [Google Scholar]
  16. Din-Dzietham R., Hertz-Picciotto I. Infant mortality differences between whites and African Americans: the effect of maternal education. Am J Public Health. 1998 Apr;88(4):651–656. doi: 10.2105/ajph.88.4.651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fikree F. F., Berendes H. W. Risk factors for term intrauterine growth retardation: a community-based study in Karachi. Bull World Health Organ. 1994;72(4):581–587. [PMC free article] [PubMed] [Google Scholar]
  18. Foster H. W., Jr, Thomas D. J., Semenya K. A., Thomas J. Low birthweight in African Americans: does intergenerational well-being improve outcome? J Natl Med Assoc. 1993 Jul;85(7):516–520. [PMC free article] [PubMed] [Google Scholar]
  19. Gates-Williams J., Jackson M. N., Jenkins-Monroe V., Williams L. R. The business of preventing African-American infant mortality. West J Med. 1992 Sep;157(3):350–356. [PMC free article] [PubMed] [Google Scholar]
  20. Gennaro S. Leave and employment in families of preterm low birthweight infants. Image J Nurs Sch. 1996 Fall;28(3):193–198. doi: 10.1111/j.1547-5069.1996.tb00351.x. [DOI] [PubMed] [Google Scholar]
  21. Geronimus A. T. Understanding and eliminating racial inequalities in women's health in the United States: the role of the weathering conceptual framework. J Am Med Womens Assoc. 2001 Fall;56(4):133-6, 149-50. [PubMed] [Google Scholar]
  22. Gifford B. D. Quality care in a medicaid managed care program: adequacy of prenatal care for teens in Chicago. Public Health Nurs. 2001 Jul-Aug;18(4):236–242. doi: 10.1046/j.1525-1446.2001.00236.x. [DOI] [PubMed] [Google Scholar]
  23. Gilbert William M., Nesbitt Thomas S., Danielsen Beate. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol. 2003 Sep;102(3):488–492. doi: 10.1016/s0029-7844(03)00617-3. [DOI] [PubMed] [Google Scholar]
  24. Goldenberg R. L., Davis R. O., Cliver S. P., Cutter G. R., Hoffman H. J., Dubard M. B., Copper R. L. Maternal risk factors and their influence on fetal anthropometric measurements. Am J Obstet Gynecol. 1993 Apr;168(4):1197–1205. doi: 10.1016/0002-9378(93)90369-t. [DOI] [PubMed] [Google Scholar]
  25. Hamvas A., Wise P. H., Yang R. K., Wampler N. S., Noguchi A., Maurer M. M., Walentik C. A., Schramm W. F., Cole F. S. The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites. N Engl J Med. 1996 Jun 20;334(25):1635–1640. doi: 10.1056/NEJM199606203342504. [DOI] [PubMed] [Google Scholar]
  26. Huddleston J. F. Preterm labor. Clin Obstet Gynecol. 1982 Mar;25(1):123–136. doi: 10.1097/00003081-198203000-00017. [DOI] [PubMed] [Google Scholar]
  27. Johnson J. W. Obstetric aspects of preterm delivery. Clin Obstet Gynecol. 1980 Mar;23(1):15–16. [PubMed] [Google Scholar]
  28. Kessel S. S., Kleinman J. C., Koontz A. M., Hogue C. J., Berendes H. W. Racial differences in pregnancy outcomes. Clin Perinatol. 1988 Dec;15(4):745–754. [PubMed] [Google Scholar]
  29. Kilpatrick S. J., Schlueter M. A., Piecuch R., Leonard C. H., Rogido M., Sola A. Outcome of infants born at 24-26 weeks' gestation: I. Survival and cost. Obstet Gynecol. 1997 Nov;90(5):803–808. doi: 10.1016/S0029-7844(97)00483-3. [DOI] [PubMed] [Google Scholar]
  30. Kogan M. D., Kotelchuck M., Johnson S. Racial differences in late prenatal care visits. J Perinatol. 1993 Jan-Feb;13(1):14–21. [PubMed] [Google Scholar]
  31. Kramer M. S., Demissie K., Yang H., Platt R. W., Sauvé R., Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA. 2000 Aug 16;284(7):843–849. doi: 10.1001/jama.284.7.843. [DOI] [PubMed] [Google Scholar]
  32. Kramer M. S. Intrauterine growth and gestational duration determinants. Pediatrics. 1987 Oct;80(4):502–511. [PubMed] [Google Scholar]
  33. Krieger N., Chen J. T., Ebel G. Can we monitor socioeconomic inequalities in health? A survey of U.S. health departments' data collection and reporting practices. Public Health Rep. 1997 Nov-Dec;112(6):481–491. [PMC free article] [PubMed] [Google Scholar]
  34. Krieger N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health. 1991 Mar;45(1):35–42. doi: 10.1136/jech.45.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Laveist T. A. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q. 1993;71(1):41–64. [PubMed] [Google Scholar]
  36. Lieberman E., Ryan K. J., Monson R. R., Schoenbaum S. C. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med. 1987 Sep 17;317(12):743–748. doi: 10.1056/NEJM198709173171206. [DOI] [PubMed] [Google Scholar]
  37. McCormick M. C., Deal L. W., Devaney B. L., Chu D., Moreno L., Raykovich K. T. The impact on clients of a community-based infant mortality reduction program: the National Healthy Start Program Survey of Postpartum Women. Am J Public Health. 2001 Dec;91(12):1975–1977. doi: 10.2105/ajph.91.12.1975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. McFarlin B. L. Intrauterine growth retardation. Etiology, diagnosis, and management. J Nurse Midwifery. 1994 Mar-Apr;39(2 Suppl):52S–65S. doi: 10.1016/0091-2182(94)90064-7. [DOI] [PubMed] [Google Scholar]
  39. McIntire D. D., Bloom S. L., Casey B. M., Leveno K. J. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med. 1999 Apr 22;340(16):1234–1238. doi: 10.1056/NEJM199904223401603. [DOI] [PubMed] [Google Scholar]
  40. Miller H. C. Prenatal factors affecting intrauterine growth retardation. Clin Perinatol. 1985 Jun;12(2):307–318. [PubMed] [Google Scholar]
  41. Miller M. K., Clarke L. L., Albrecht S. L., Farmer F. L. The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care. J Rural Health. 1996 Winter;12(1):6–18. doi: 10.1111/j.1748-0361.1996.tb00768.x. [DOI] [PubMed] [Google Scholar]
  42. Nagey D. A. The content of prenatal care. Obstet Gynecol. 1989 Sep;74(3 Pt 2):516–528. [PubMed] [Google Scholar]
  43. Nagy M. C., Leeper J. D., Hullett S., Northrup R., Newell W. H. The rural Alabama pregnancy and infant health program. Fam Community Health. 1988 Aug;11(2):49–56. doi: 10.1097/00003727-198808000-00008. [DOI] [PubMed] [Google Scholar]
  44. Parker J. D., Schoendorf K. C., Kiely J. L. Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States. Ann Epidemiol. 1994 Jul;4(4):271–278. doi: 10.1016/1047-2797(94)90082-5. [DOI] [PubMed] [Google Scholar]
  45. Roberts C., Mueller L., Hadler J. Birth-weight percentiles by gestational age, Connecticut 1988-1993. Conn Med. 1996 Mar;60(3):131–140. [PubMed] [Google Scholar]
  46. Sappenfield W. M., Buehler J. W., Binkin N. J., Hogue C. J., Strauss L. T., Smith J. C. Differences in neonatal and postneonatal mortality by race, birth weight, and gestational age. Public Health Rep. 1987 Mar-Apr;102(2):182–192. [PMC free article] [PubMed] [Google Scholar]
  47. Scott-Wright A. O., Wrona R. M., Flanagan T. M. Predictors of infant mortality among college-educated black and white women, Davidson County, Tennessee, 1990-1994. J Natl Med Assoc. 1998 Aug;90(8):477–483. [PMC free article] [PubMed] [Google Scholar]
  48. Shiono P. H., Klebanoff M. A., Rhoads G. G. Smoking and drinking during pregnancy. Their effects on preterm birth. JAMA. 1986 Jan 3;255(1):82–84. [PubMed] [Google Scholar]
  49. Singh G. K., Yu S. M. Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. Am J Public Health. 1995 Jul;85(7):957–964. doi: 10.2105/ajph.85.7.957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Starfield B., Shapiro S., Weiss J., Liang K. Y., Ra K., Paige D., Wang X. B. Race, family income, and low birth weight. Am J Epidemiol. 1991 Nov 15;134(10):1167–1174. doi: 10.1093/oxfordjournals.aje.a116020. [DOI] [PubMed] [Google Scholar]
  51. Taffel S., Johnson D., Heuser R. A method of imputing length of gestation on birth certificates. Vital Health Stat 2. 1982 May;(93):1–11. [PubMed] [Google Scholar]
  52. Wen S. W., Goldenberg R. L., Cutter G. R., Hoffman H. J., Cliver S. P. Intrauterine growth retardation and preterm delivery: prenatal risk factors in an indigent population. Am J Obstet Gynecol. 1990 Jan;162(1):213–218. doi: 10.1016/0002-9378(90)90853-y. [DOI] [PubMed] [Google Scholar]
  53. Zambrana R. E., Dunkel-Schetter C., Collins N. L., Scrimshaw S. C. Mediators of ethnic-associated differences in infant birth weight. J Urban Health. 1999 Mar;76(1):102–116. doi: 10.1007/BF02344465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Zambrana R. E., Dunkel-Schetter C., Scrimshaw S. Factors which influence use of prenatal care in low-income racial-ethnic women in Los Angeles County. J Community Health. 1991 Oct;16(5):283–295. doi: 10.1007/BF01320336. [DOI] [PubMed] [Google Scholar]
  55. Zambrana R. E., Scrimshaw S. C. Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women. Pediatr Nurs. 1997 May-Jun;23(3):253-9, 274. [PubMed] [Google Scholar]

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