246340 Do socioeconomic and healthcare indicators account for the high preterm birth rate in the United States? A comparison with France

Sunday, October 30, 2011

Jennifer Zeitlin, DSc , Epidemiological Research Unit on Perinatal Health and Women's and Children's Health; UPMC Univ Paris6, French Institute for Health and Medical Research (INSERM), Paris, France
Béatrice Blondel, PhD , Epidemiological Research on Perinatal and Women's Health, INSERM, UMR S953, Paris, France
Cande Ananth, PhD, MPH, MS , Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
Context: The United States has higher rates of preterm birth than France. We examined if differences in the socio-demographic characteristics of pregnant women and the use of medical interventions at birth may have contributed to this excess. Methods: Our study included live singleton births in 1995, 1998 and 2003 from the French National Perinatal Sample Survey (n=39,656) and from US birth certificates (n=10,026,891). Preterm birth (< 37 weeks gestation) was based on clinical estimates. We analyzed maternal risk factors (age <20 and >=35, nulliparous and high parity, unmarried, low educational attainment, race (US)/nationality (France), late prenatal care and smoking) and use of cesarean section and induction of labor. Results: The preterm birth rate was 8.1% in the US and 4.8% in France (OR=1.74 [95% CI 1.67-1.83]). Some risk factors were more prevalent in the US (age <20: 12.3% versus 2.6%, parity 4+: 9.1% versus 2.9%, late first prenatal visit: 16.5% versus 4.5%), but fewer women smoked: 13.5% versus 24.0%. Adjustment for these factors did not explain the US excess risk (1.79 [95% CI 1.71-1.89]). Rates of preterm birth with labor induction or cesarean were 3.4% in the US and 2.2% in France (1.58 [95% CI 1.48-1.69] and of preterm birth without any intervention, 4.7% and 2.6% (1.83 [95% CI 1.72-1.95]). Conclusions: Maternal risk factors and higher rates of obstetrical intervention did not explain differences between the US and France. Future research should explore whether France's social and health policies promote better care during pregnancy and reduce maternal stress.

Learning Areas:
Diversity and culture
Public health or related public policy
Public health or related research

Learning Objectives:
List differences in maternal risk factors and medical interventions at birth in the US and in France and assess whether these differences explain the higher rates of preterm birth in the US.

Keywords: Pregnancy Outcomes, Infant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a tenured perinatal epidemiologist at the French Institute for Health and Medical Research and have studied risk factors for preterm birth; My research program also includes study of inter-country differences in health outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.