Health Disparities Beginning Prenatally: Risk Factors and Birth Outcomes Among American Indians in North Dakota

Background: Infant mortality rates among American Indians (AI) in North Dakota (ND) contribute to an average lifespan that is 20 years shorter than whites. Health disparities that begin prenatally can have long-lasting implications. Knowledge of state-specific AI prenatal disparities and outcomes are not well disseminated.

Methods: Data from birth and death records from the ND Department of Health Division of Vital Records was examined, including period prevalence of a variety of risk factors and birth outcomes by race of the mother.

Results: From 2010-2012, 10% of births in ND were to AI mothers. Infants born to AI mothers were more likely to experience prenatal risk factors than infants born to white mothers, including inadequate prenatal care, teen births, smoking, drinking, or using illegal drugs during pregnancy, and gestational diabetes. Infants born to AI mothers were also more likely to experience poor birth outcomes, including preterm birth, low birth weight, and infant mortality.

Conclusions: AI mothers in ND are more likely to experience prenatal risk factors and poor birth outcomes compared to infants born to white mothers. Statewide efforts to reduce poor outcomes for AI children include the Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) focusing on safe sleep, smoking cessation, social determinants of health, and prevention of preterm deliveries with targeted outreach to the state’s tribal communities.