IJE Advance Access originally published online on July 17, 2006
International Journal of Epidemiology 2006 35(5):1187-1195; doi:10.1093/ije/dyl125
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US Black vs White disparities in foetal growth: physiological or pathological?
1 Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
2 Department of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
3 Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA
4 The Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynecology, and Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
* Corresponding author. Institute of Human Development and Child and Youth Health, Canadian Institutes of Health Research, 2300 Tupper Street (Les Tourelles), Montreal, Quebec H3H 1P3, Canada. E-mail: michael.kramer{at}mcgill.ca
Background Birthweight for gestational age is lower in US Black infants than in US White infants. It is unknown, however, whether this difference is ‘normal’ (i.e. physiological) or reflects pathological foetal growth restriction.
Methods We applied an analytic approach based on foetuses at risk to compare gestational age-specific rates of live birth, ‘revealed’ small-for-gestational-age (SGA), and neonatal mortality among singleton infants 
22 weeks of gestation and 500 g born in 1998–2000 to US White (n = 9 012 194), US-born Black (n = 1 554 382), and foreign-born Black (n = 200 395) mothers. Graphical methods and Cox proportional hazards regression analyses were used to compare outcomes in the three ethnic groups.
Results Rates of live birth and neonatal mortality were highest at all gestational ages in US-born Blacks, lowest in Whites, and intermediate in foreign-born Blacks. The revealed SGA pattern cohered much more closely with the observed pattern for neonatal mortality when SGA was defined based on a single, overall standard of birthweight for gestational age than when based on ethnic group-specific standards.
Conclusion The closer coherence of revealed SGA and neonatal mortality rates based on a single standard and the intermediate pattern among foreign-born Blacks strongly suggest that Black–White differences in birthweight for gestational age are pathological, rather than physiological.
Keywords foetal growth, small-for-gestational-age, intrauterine growth restriction, racial/ethnic disparities
Accepted 5 May 2006
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