Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort


      Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood.


      Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression.


      U.S.-born women in all 3 racial–ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different.


      Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chawanpaiboon S
        • Vogel JP
        • Moller AB
        • et al.
        Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.
        Lancet Glob Health. 2019; 7: e37-e46
        • Hamilton BE
        • Martin JA
        • Osterman MJK.
        Vital statistics rapid release births: provisional data for 2020.
        Centers for Disease Control and Prevention, Atlanta, GAMay 2021 (Accessed June 24, 2021)
      1. Newborns: improving survival and well-being. WHO. September 19, 2020. Accessed June 24, 2021.

        • Crump C
        • Groves A
        • Sundquist J
        • Sundquist K.
        Association of preterm birth with long-term risk of heart failure into adulthood.
        JAMA Pediatr. 2021; 175: 689-697
        • Crump C
        • Sundquist J
        • Howell EA
        • McLaughlin MA
        • Stroustrup A
        • Sundquist K.
        Pre-term delivery and risk of ischemic heart disease in women.
        J Am Coll Cardiol. 2020; 76: 57-67
        • Crump C
        • Sundquist J
        • Sundquist K.
        Preterm delivery and long-term risk of stroke in women: a national cohort and cosibling study.
        Circulation. 2021; 143: 2032-2044
        • Robbins CL
        • Hutchings Y
        • Dietz PM
        • Kuklina EV
        • Callaghan WM.
        History of preterm birth and subsequent cardiovascular disease: a systematic review.
        Am J Obstet Gynecol. 2014; 210: 285-297
        • Minissian MB
        • Kilpatrick S
        • Eastwood JA
        • et al.
        Association of spontaneous preterm delivery and future maternal cardiovascular disease.
        Circulation. 2018; 137: 865-871
      2. Cardiovascular disease: women's no. 1 health threat. American Heart Association. Updated March 2018. Accessed June 28, 2021.

        • Wu P
        • Gulati M
        • Kwok CS
        • et al.
        Preterm delivery and future risk of maternal cardiovascular disease: a systematic review and meta-analysis.
        J Am Heart Assoc. 2018; 7e007809
        • Grobman WA
        • Parker CB
        • Willinger M
        • et al.
        Racial disparities in adverse pregnancy outcomes and psychosocial stress.
        Obstet Gynecol. 2018; 131: 328-335
        • Manuck TA.
        Racial and ethnic differences in preterm birth: a complex, multifactorial problem.
        Semin Perinatol. 2017; 41: 511-518
        • Schaaf JM
        • Liem SM
        • Mol BW
        • Abu-Hanna A
        • Ravelli AC.
        Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis.
        Am J Perinatol. 2013; 30: 433-450
        • Commodore-Mensah Y
        • Ukonu N
        • Cooper LA
        • Agyemang C
        • Himmelfarb CD.
        The association between acculturation and cardiovascular disease risk in Ghanaian and Nigerian-born African immigrants in the United States: the Afro-Cardiac Study.
        JImmigr Minor Health. 2018; 20: 1137-1146
        • Koya DL
        • Egede LE.
        Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants.
        J Gen Intern Med. 2007; 22: 841-846
        • Redfield R
        • Linton R
        • Herskovits MJ.
        Memorandum for the study of acculturation.
        Am Anthropol. 1936; 38: 149-152
        • Boakye E
        • Sharma G
        • Ogunwole SM
        • et al.
        Relationship of preeclampsia with maternal place of birth and duration of residence among non-Hispanic Black women in the United States.
        Circ Cardiovasc Qual Outcomes. 2021; 14e007546
        • Wang X
        • Zuckerman B
        • Pearson C
        • et al.
        Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight.
        JAMA. 2002; 287: 195-202
        • Wang G
        • Divall S
        • Radovick S
        • et al.
        Preterm birth and random plasma insulin levels at birth and in early childhood.
        JAMA. 2014; 311: 587-596
        • Commodore-Mensah Y
        • Ukonu N
        • Obisesan O
        • et al.
        Length of residence in the United States is associated with a higher prevalence of cardiometabolic risk factors in immigrants: a contemporary analysis of the National Health Interview Survey.
        J Am Heart Assoc. 2016; 5e004059
      3. Preterm birth. Centers for Disease Control and Prevention. Updated November 1, 2021. Accessed June 27, 2021.

        • Braveman PA
        • Heck K
        • Egerter S
        • et al.
        The role of socioeconomic factors in black–white disparities in preterm birth.
        Am J Public Health. 2015; 105: 694-702
        • Miller LS
        • Robinson JA
        • Cibula DA.
        Healthy immigrant effect: preterm births among immigrants and refugees in Syracuse, NY.
        Matern Child Health J. 2016; 20: 484-493
        • Elsayed A
        • Amutah-Onukagha NN
        • Navin L
        • Gittens-Williams L
        • Janevic T.
        Impact of immigration and duration of residence in U.S. on length of gestation among Black women in Newark, New Jersey.
        J Immigr Minor Health. 2019; 21: 1095-1101
        • DeSisto CL
        • McDonald JA.
        Variation in birth outcomes by mother's country of birth among Hispanic women in the United States, 2013.
        Public Health Rep. 2018; 133: 318-328
        • Urquia ML
        • Frank JW
        • Moineddin R
        • Glazier RH.
        Immigrants’ duration of residence and adverse birth outcomes: a population-based study.
        BJOG. 2010; 117: 591-601
        • Kennedy S
        • Kidd MP
        • McDonald JT
        • Biddle N.
        The healthy immigrant effect: patterns and evidence from four countries.
        J Int Migr Integr. 2015; 16: 317-332
      4. Jassoh G. Immigrant health–selectivity and acculturation. London, United Kingdom: The Institute for Fiscal Studies.–Selectivity_and_Acculturation. Published January 2004. Accessed June 27, 2021.

        • Ion R
        • Bernal AL.
        Smoking and preterm birth.
        Reprod Sci. 2015; 22: 918-926
        • Ko TJ
        • Tsai LY
        • Chu LC
        • et al.
        Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study.
        Pediatr Neonatol. 2014; 55: 20-27
        • Liu B
        • Xu G
        • Sun Y
        • et al.
        Maternal cigarette smoking before and during pregnancy and the risk of preterm birth: a dose–response analysis of 25 million mother–infant pairs.
        PLoS Med. 2020; 17e1003158
        • Rohlfing AB
        • Nah G
        • Ryckman KK
        • et al.
        Maternal cardiovascular disease risk factors as predictors of preterm birth in California: a case–control study.
        BMJ Open. 2020; 10e034145
        • Antecol H
        • Bedard K.
        Unhealthy assimilation: why do immigrants converge to American health status levels?.
        Demography. 2006; 43: 337-360
        • Barbieri PN.
        The heterogeneity in immigrants unhealthy assimilation.
        Munich Personel RePEc Archive, Munich, Germany2016 (Accessed January 13, 2022)
        • Giuntella O
        • Stella L.
        The acceleration of immigrant unhealthy assimilation.
        Health Econ. 2017; 26: 511-518
        • Kandula NR
        • Kersey M
        • Lurie N.
        Assuring the health of immigrants: what the leading health indicators tell us.
        Annu Rev Public Health. 2004; 25: 357-376
        • Su XJ
        • Huang SJ
        • Li X
        • Du QL.
        Prepregnancy overweight and obesity are associated with an increased risk of preterm birth in Chinese women.
        Obes Facts. 2020; 13: 237-244
        • Liu B
        • Xu G
        • Sun Y
        • et al.
        Association between maternal pre-pregnancy obesity and preterm birth according to maternal age and race or ethnicity: a population-based study.
        Lancet Diabetes Endocrinol. 2019; 7: 707-714
        • Cnattingius S
        • Villamor E
        • Johansson S
        • et al.
        Maternal obesity and risk of preterm delivery.
        JAMA. 2013; 309: 2362-2370
        • Marchi J
        • Berg M
        • Dencker A
        • Olander EK
        • Begley C.
        Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.
        Obes Rev. 2015; 16: 621-638
        • Ramsay JE
        • Ferrell WR
        • Crawford L
        • Wallace AM
        • Greer IA
        • Sattar N.
        Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways.
        J Clin Endocrinol Metab. 2002; 87: 4231-4237
        • Guendelman S
        • Kosa JL
        • Pearl M
        • Graham S
        • Kharrazi M.
        Exploring the relationship of second-trimester corticotropin releasing hormone, chronic stress and preterm delivery.
        J Matern Fetal Neonatal Med. 2008; 21: 788-795
        • Wheeler S
        • Maxson P
        • Truong T
        • Swamy G.
        Psychosocial stress and preterm birth: the impact of parity and race.
        Matern Child Health J. 2018; 22: 1430-1435
        • Almeida J
        • Bécares L
        • Erbetta K
        • Bettegowda VR
        • Ahluwalia IB.
        Racial/ethnic inequities in low birth weight and preterm birth: the role of multiple forms of stress.
        Matern Child Health J. 2018; 22: 1154-1163
        • Hales CM
        • Carroll MD
        • Fryar CD
        • Ogden CL.
        Prevalence of obesity among adults and youth: United States, 2015‒=-2016.
        NCHS Data Brief. 2017; (Accessed June 28, 2021): 1-8
        • Bond RM
        • Gaither K
        • Nasser SA
        • et al.
        Working agenda for Black mothers: a position paper from the Association of Black Cardiologists on solutions to improving Black maternal health.
        Circ Cardiovasc Qual Outcomes. 2021; 14e007643
        • Bushnell C
        • McCullough LD
        • Awad IA
        • et al.
        Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 1545-1588
        • Perak AM
        • Lancki N
        • Kuang A
        • et al.
        Associations of maternal cardiovascular health in pregnancy with offspring cardiovascular health in early adolescence.
        JAMA. 2021; 325: 658-668