Racial and ethnic disparities in universal cervical length screening with transvaginal ultrasound

Abstract

Objective: Determine if race or ethnicity is associated with missed or late transvaginal cervical length screening in a universal screening program.

Methods: Retrospective cohort study of nulliparous women with singleton gestations and a fetal anatomical ultrasound from 16–24 weeks’ gestation from January 2012 to November 2013. We classified women into mutually exclusive racial and ethnic groups: non-Hispanic black (black), Hispanic, Asian, non-Hispanic white (white), and other or unknown race. We used log-binomial regression to calculate the risk ratio (RR) and 95% confidence interval (CI) of missed or late (≥20 weeks’ gestation) screening versus optimally timed screening between the different racial and ethnic groups.

Results: Among the 2967 women in our study population, 971 (32.7%) had either missed or late cervical length screening. Compared to white women, black (RR: 1.3; 95% CI: 1.1–1.5) and Hispanic (RR:1.2; 95% CI: 1.01–1.5) women were more likely to have missed or late screening. Among women screened, black (versus white) women were more likely to be screened late (RR: 2.2; 95% CI: 1.6–3.1).

Conclusions: Black and Hispanic women may be more likely to have missed or late cervical length screenings.

Keywords:

• Antenatal screening
• racial/ethnic disparity
• risk of preterm birth
• transvaginal cervical length screening
• universal screening program

Acknowledgements

The authors would like to thank Anna Merport Modest and JoAnn Jordan for their help with creating the dataset used in this study.

Declaration of interest

The authors report no declaration of interest.

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health-care centers.

Dr. H.H.B is funded by NIH/NIEHS K23 ES022242.