RACIAL DISPARITIES IN PRETERM BIRTHS - THE ROLE OF UROGENITAL INFECTIONS

Objectives: To evaluate the impact of urogenital infections the racial gap between black and white women in preterm birth rates. Methods: A computer-assisted search of the medical literature was conducted throu gh MEDLINE aided by a manual bibliographic search of published article s and relevant books. Estimates of the relative risk for preterm birth were extracted from published studies for the following infections: N . gonorrhea, syphilis, trichomoniasis, Chlamydia trachomatis, Group B streptococcal vaginal colonization, asymptomatic bacteriuria, genital mycoplasmas, and bacterial vaginosis. Estimates of the prevalence amon g black and white women by race for each of these infections were extr acted from published studies. The attributable risk for preterm birth for selected infections was then calculated for the black and white po pulations acid the impact on the racial gap in preterm births was esti mated. Results: Only bacterial vaginosis and bacteriuria appear to be established risk factors for preterm births. Significantly higher rate s of bacterial vaginosis among black women may account for nearly 30% of the racial gap in preterm births. Higher rates of bacteriuria among black women may account for roughly 5% of the gap. Conclusion: Althou gh these findings are limited by the reliability of published estimate s of prevalence and relative risk for these infections, treatment of i nfections during pregnancy, particularly bacterial vaginosis, offers h ope for reducing the racial gap in preterm births.