Dr. Martha S. Wingate, associate professor in the department of health care organization and policy at the University of Alabama at Birmingham, recently compared fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995 to 1998 and 2005 to 2008.
Dr. Wingate and fellow researchers examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day, and cause-specific deaths. They calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with Black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods. Over time, late fetal death for AIANs decreased 17 percent, but the team noted a 47 percent increased risk over time for Hispanics.
Study data indicated no change over time among AIANs for first day death. For AIANs compared with Whites, increased risks and disparities persisted for mortality due to congenital anomalies. For Blacks compared with AIANs, the increased risks of fetal death persisted. For Hispanics, lower risks compared with AIANs persisted, but protective effect declined over time. Disparities between AIAN and other groups persist, but there is variability by race/ethnicity in improvement of perinatal outcomes over time.
The researchers concluded that variability in access to care and pregnancy management should be considered in relation to health equity for fetal and early infant deaths.
“Perinatal Disparities Between American Indians and Alaska Natives and Other U.S. Populations: Comparative Changes in Fetal and First Day Mortality, 1995-2008” was published in February in Maternal and Child Health Journal.