Racial and ethnic differences in preterm birth: A complex, multifactorial problem

Semin Perinatol. 2017 Dec;41(8):511-518. doi: 10.1053/j.semperi.2017.08.010. Epub 2017 Sep 21.


Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates, and is a major public health problem. Non-Hispanic black women have a 2-fold greater risk for preterm birth compared with non-Hispanic white race. The reasons for this disparity are poorly understood and cannot be explained solely by sociodemographic factors. Underlying factors including a complex interaction between maternal, paternal, and fetal genetics, epigenetics, the microbiome, and these sociodemographic risk factors likely underlies the differences between racial groups, but these relationships are currently poorly understood. This article reviews the epidemiology of disparities in preterm birth rates and adverse pregnancy outcomes and discuss possible explanations for the racial and ethnic differences, while examining potential solutions to this major public health problem.

Keywords: Neonatal outcomes; Perinatal epidemiology; Preterm birth; Racial disparity.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Black or African American / statistics & numerical data
  • Cross-Cultural Comparison
  • Female
  • Genetic Predisposition to Disease / epidemiology*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Outcome
  • Premature Birth / epidemiology*
  • Premature Birth / ethnology*
  • Prenatal Care / statistics & numerical data*
  • Public Health*
  • Racial Groups / statistics & numerical data*
  • Socioeconomic Factors
  • United States / epidemiology
  • White People / statistics & numerical data