349 - The Favorable Impact of Paternal Involvement on the Outcome of Subsequent Births to African-American Women Whose Prior Births Had Non-Involved Fathers.

Publication Number: 349.6820

John M. Perry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Rachel A. Wilkinson, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Kristin Rankin, University of Illinois at Chicago School of Public Health, Chicago, IL, United States; Shayna Hibbs, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; James Collins, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: The racial disparity in adverse birth outcomes is a long-standing public health challenge. Paternal non-involvement (as measured by non-acknowledgement on their infant’s birth certificate) is a strong risk factor for adverse birth outcome. Most pertinent, approximately one-third of African-American (AA) women’s births occur with non-acknowledged (non-ack) fathers.

Objective: To determine whether paternal acknowledgement is associated with rates of small for gestational age birth (weight for gestational age < 10th percentile, SGA) and preterm birth ( < 37 weeks gestational age, PTB) among the subsequent births to AA women whose prior births had non-ack fathers.

Design/Methods: Stratified and multivariable modified Poisson regression analyses were performed on the Illinois transgenerational birth-file of singleton births to AA women (n=5,224) that followed a prior singleton birth (1989-1991) with a non-ack father on their birth certificate. Mediation analyses assessed the contribution of selected pregnancy-related risk factors (inadequate prenatal care usage, suboptimal weight gain, and cigarette smoking) to the association of paternal acknowledgement and adverse birth outcome.

Results: Among AA women whose prior births had non-ack fathers, 20% of subsequent births had acknowledged fathers. The SGA rate was lower among subsequent births who had acknowledged (compared to non-ack) fathers: 16.4 % vs 20.0%, RR = 0.82 (95% CI = 0.71, 0.95) (Figure 1). With respect to PTB, a similar association occurred with the early ( < 34 weeks gestational age) component: 6.5% vs 8.6%, RR = 0.75 (0.59, 0.96) (Figure 1). Subsequent births with acknowledged fathers had a greater percentage of low-risk maternal sociodemographic characteristics than those with non-ack fathers (Table 1). Most striking, the adjusted (controlling for maternal education and parity) RR of SGA and early PTB for subsequent-born infants with acknowledged (compared to non-ack) fathers equaled 0.82 (0.70, 0.95) and 0.78 (0.60, 1.01), respectively. The incidence of inadequate prenatal medical care and cigarette smoking were lower for subsequent-born infants with acknowledged (vs non-ack) fathers (Figure 2). However, our mediation analyses showed that AA women’s selected pregnancy-related risk factors were not responsible for excess disparity in SGA rates for non-ack fathers.

Conclusion(s): Our population-based study highlights a protective effect of paternal involvement on SGA rates for subsequent births to AA women whose prior births had non-involved fathers. This intriguing finding is not adequately explained by selected pregnancy-related behaviors.

Figure 1: Adverse Infant Outcome According to Paternal Acknowledgement in Subsequent Births to African-American Mother's With Paternally Non-Acknowledged Prior Births.


Table 1: Distribution of Maternal Characteristics According to Paternal Acknowledgment in Subsequent Births of African-American Mothers.


Figure 2: Distribution of African-American Women’s Selected Pregnancy-Related Risk Factors According to Paternal Acknowledgement.