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      To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort

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          Abstract

          Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011–2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.

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          Author and article information

          Journal
          Am J Epidemiol
          Am J Epidemiol
          aje
          American Journal of Epidemiology
          Oxford University Press
          0002-9262
          1476-6256
          November 2020
          14 April 2020
          14 April 2021
          : 189
          : 11
          : 1360-1368
          Author notes
          Correspondence to Khalidha Nasiri, Schulich School of Medicine, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada (e-mail: knasiri@ 123456uwo.ca ).
          Article
          PMC7604519 PMC7604519 7604519 kwaa054
          10.1093/aje/kwaa054
          7604519
          32285132
          44a1525a-d411-45e2-aed9-a24125c4ddc6
          © The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

          This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

          History
          : 13 May 2019
          : 28 March 2020
          : 31 March 2020
          Page count
          Pages: 09
          Funding
          Funded by: funder-nameBest Canada Graduate Scholarship) in support of her research;
          Funded by: funder-nameCanadian Institutes of Health Research, funder-identifierDOI 10.13039/501100000024;
          Categories
          AcademicSubjects/MED00860
          Original Contribution

          fetal growth retardation,cohort studies,race/ethnicity,prenatal care,intrauterine growth restriction,infant, small for gestational age,infant,health disparities

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