Another look at the black-white gap in gestation-specific perinatal mortality

Abstract

In the US, black infants born near or at term experience higher mortality than white infants. To extend our understanding of black-white differences in the relative advantages of growth (measured by birthweight) for gestational age, we compared race-specific rates of perinatal mortality by deviation in grams from the median birthweight for four categories of gestation (35-36, 37-38, 39-41, and 42-43 weeks). We also used race-specific standards to examine the difference between the median birthweight and the optimum birthweight (i.e. birthweight with the lowest mortality). The data, which were derived from vital records for singletons delivered in the US from 1983-1984, comprised 24,626 fetal and neonatal deaths among 5,157,197 white infants and 5973 fetal and neonatal deaths among 926,678 black infants. At all deviations from the median birthweight, black infants had relatively better survival at 35-36 weeks of gestation. This advantage was reversed among infants with gestations of 39-41 and 42-43 weeks. The optimum birthweight for black infants with gestations greater than or equal to 37 weeks was closer to their median birthweight than was that for white infants. For black infants with gestations of 39-41 weeks, the optimum birthweight was 187g (95% confidence interval (CI): 150-234) greater than the median birthweight (3289g); for comparable white infants the optimum birthweight was 397g (95% CI: 366-431) greater than the median birthweight (3487g). To reduce the black-white gap in perinatal mortality, we need a better understanding of aetiological relations between gestation, growth, and mortality.