fbpx

Impact of Paternal Race and Educational Status on Pregnancy Outcome among Paternity Acknowledged Births in the United States

By Oluwasegun Akinyemi, Kindha Elleissy Nasef, Christabel Ojieabu, Christina Lipscombe, Oluwakemi Adeola

Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn

Citation

Akinyemi O, Elleissy Nasef K, Ojieabu C, Lipscombe C, Adeola O. Impact of paternal race and educational status on pregnancy outcome among paternity acknowledged births in the united states. HPHR. 2021;36. 

DOI:10.54111/0001/JJ3

Impact of Paternal Race and Educational Status on Pregnancy Outcome among Paternity Acknowledged Births in the United States

Abstract

Introduction:

Several studies have explored the role of maternal parameters on pregnancy outcome; however, very few studies have examined the interaction between paternal race/ethnicity and educational status.  

Aim:

To determine the interaction between paternal race/ethnicity and educational level and how this interaction influences pregnancy outcome among paternity acknowledged births in the USA.

Methods:

We utilized the US Vital Statistics records to collate paternal characteristics of paternally acknowledged births between 2015-2019. We conducted a multivariate analysis with an interaction term to determine the interaction between paternal race and education. We then ascertained how the interaction influences pregnancy outcomes across eight outcome measures. These outcome measures included infant mortality, breastfeeding, 5 min Apgar score, neonatal unit admission, neonates receiving assisted ventilation > 6 hours following delivery, cesarean section, mothers requiring blood transfusion, and admission to the intensive care unit.

Results:

There were a total of 4 555,334 paternity acknowledged pregnancies in the study period. About 23% of the women declined to breastfeed after delivery. Across all races/ethnicities, there was a significant association between paternal education, increased cesarean section rate, and increased uptake of breastfeeding. Having a Hispanic father was associated with the highest odds of breastfeeding (OR=1.78; 95% CI 1.76-1.79). Despite having a higher risk of NICU admission, Poor 5min- Apgar score, and assisted ventilation, there was no difference in neonatal mortality rate between White fathers and any other race/ethnicities.

Conclusions:

Paternal race and educational status significantly impact pregnancy outcomes among paternity acknowledged births in the United States. The study highlights the importance of including paternal parameters in algorithms designed to improve pregnancy outcomes.

Introduction

Many studies identify maternal risk factors for adverse pregnancy outcomes with far less attention given to paternal factors that could also predict adverse birth outcomes.1

 

Paternal characteristics like smoking have been linked to maternal anxiety and depression during pregnancy, with a subsequent increased risk of preterm births (PTB).2,3 In addition, paternal age has been associated with a wide array of adverse health effects in offspring, including but not limited to autism spectrum disorders (ASDs) and schizophrenia;4 however, the mechanisms explaining these associations remain unclear.

 

Several studies in the United States have recognized paternal involvement to impact pregnancy and infant outcomes.5,6 These studies identified that paternal involvement during pregnancy is significantly associated with reduced maternal negative health behaviors especially smoking, alcohol use, and inadequate prenatal care visits;7 reduced risk of preterm birth, low birth weight and fetal growth restriction,5,7,8 infant mortality up to one year after birth6 and substantial reductions in gaps in infant mortality between Black and white pregnant women.9

 

Research on paternal involvement in developing countries is not prevalent, but the few available ones have shown that father involvement positively affects maternal and child health outcomes. In most developing countries, men are primarily responsible for decision-making concerning women and are in charge of the decisions made concerning a woman’s health and her access to maternal health services. They also tend to be the primary providers, affecting women’s access to financial resources and indirectly their access to health care.10 Despite the traditional and cultural aspects in the developing world that may seem constrictive of a woman’s access to health, paternal involvement still correlates with decreased childbirth complications and significant benefits for the mother. In low- and middle-income countries in South Asia and Africa, paternal involvement increases maternal health services, including skilled birth attendance, post-partum visit uptakes, and an increase in the mother’s knowledge of danger signs and contraception.11

 

Findings from the Pregnancy Risk Assessment Monitoring System 2000-2003 data show that early prenatal care was less likely when fathers were reportedly ambivalent or outrightly did not want the pregnancy.12 Further, the Fragile Families study found that fathers’ prenatal financial and in-kind financial contributions were associated with higher rates of prenatal care and lower rates of maternal alcohol use.13

 

Paternal parameters such as race, education, and socioeconomic status play a significant role in pregnancy outcomes and maybe the essential missing pieces of the health disparities in pregnancy outcomes. Therefore, this study aims to assess further the impact of these factors and how the interaction between paternal race and educational level affects pregnancy outcomes in the United States.

Methods

We utilized the US Vital Statistic records for this study to collect the desired paternal characteristics of paternally acknowledged births between 2015-2019. The National Vital Statistics system provides complete data on births and maternal and fetal deaths in the United States. The database is legally responsible for registering important life events, including births, deaths, marriages, divorces, and fetal deaths.14 We restricted our study population to paternity acknowledged births to ensure documented evidence of the father’s involvement in the pregnancy.

Population

We analyzed a total of 4,555,334 paternity acknowledged pregnancies between 2015 and 2019. We identified eight outcome measures: infant mortality, breastfeeding, 5 min Apgar score, neonatal unit admission, neonates receiving assisted ventilation for more than 6 hours following delivery, cesarean section, and mothers requiring blood transfusion and admission to the ICU.

 

Paternity acknowledged pregnancy is where the child’s father accepts responsibility for pregnancy by legally acknowledging their paternity after the child is born.

Characteristics and Risk Factors

We determined the association between paternal characteristics and eight pregnancy outcomes. The paternal characteristics studied were race/ethnicity and paternal education defined as Non-Hispanic White, Non-Hispanic Black, Hispanic, Asian, mixed race and others. In addition, we defined paternal education level as high school education or lower, college education, and advanced education.

Covariates

Covariates included in the study were paternal age, maternal age, maternal race/ethnicity, insurance type, Gestational age at delivery, birth weight, weight gain during pregnancy, premorbid conditions such as chronic hypertension, diabetes, gestational diabetes (GDM), pre-pregnancy body mass index ( BMI), induction and augmentation of labor.

Statistical Analysis

We expressed Categorical variables as frequencies and percentages and continuous variables as mean ± standard deviations. Chi-square and the independent sample t-test were utilized to compare categorical and continuous variables. We used multivariate logistic regression analysis to determine the interaction between paternal outcome race/ethnicities, educational level, and pregnancy outcomes. The final multivariate analysis includes covariates such as paternal age, maternal age, maternal race/ethnicity, insurance type, gestational age at delivery, birth weight, weight gain during pregnancy. We also controlled for premorbid conditions such as chronic hypertension, diabetes, GDM, pre-pregnancy obesity, and labor procedures such as induction and augmentation. A 2-tailed p-value < 0.05 was regarded as statistically significant. All statistical analyses were performed using the STATA 16 (StataCorp College Station, TX).

Results

Table 1: Study Outcome Measures

 

Frequency

Percentages (N=4,133,227)

Neonatal Intensive Care Unit Admission (NICU)

422,107

9.27

5-Min Apgar Score (< 7)

96,638

2.12

Cesarean Section

1,439,372

31.60

Assisted Ventilation > 6 hours (AsVent)

69,796

1.53

Maternal Transfusion (MatTransf)

19,375

0.43

Intensive Care Unit Admission (InCare)

7,018

0.15

Neonatal Mortality

8,451

0.19

Breast Feeding (Yes)

3,486,533

76.54

Table 1 shows the baseline frequency distribution of study outcome measures. The majority of the women (76.5%) in the study opted for breastfeeding after delivery. Neonatal mortality also remains relatively low at 0.19% compared to the national average. The cesarean section rate was 31.6% which reflects the increasing cesarean section rate in the country.

Table 2: Association Between Paternal Race/Ethnicity and Pregnancy Outcome

Variables NICU AsVent Apgar MatTransf InCare CS  (Yes) Mortality Breast Feeding
Black (Reference)                
White

1.003

(1.01-1.04)*

1.25
(1.21-1.29)*
1.09
(1.07-1.12)*
1.11
(1.05-1.18)*
1.04
(0.94-1.15)
1.06
(1.05-1.07)*
1.05
(0.96-1.15)
1.29
(1.28-1.30)*
Hispanic 1.01
(0.99-1.03)
1.04
(1.01-1.08)*
0.82
(0.80-0.85)*
1.01
(0.95-1.08)
1.06
(0.95-1.18)
0.95
(0.94-0.96)*
0.97
(0.88-1.07)
1.78
(1.76-1.79)*
Asian 0.90
(0.86-0.94)*
0.83
(0.75-0.92)*
0.90
(0.82-0.98)*
0.88
(0.74-1.05)
0.77
(0.59-1.02)
0.81
(0.79-0.83)*
1.11
(0.84-1.49)
1.16
(1.13-1.20)*
Mixed 1.00
(0.98-1.03)
1.16
(1.09-1.22)*
1.07
(1.02-1.12)*
1.06
(1.95-1.17)*
0.98
(0.82-1.17)
0.94
(0.92-0.96)*
0.83
(0.70-1.00)
1.40
(1.38-1.42)*
Other 0.86
(0.82-0.90)*
1.19
(1.09-1.30)*
1.12
(1.05-1.20)*
1.33
(1.17-1.52)*
0.84
(0.65-1.10)
0.82
(0.80-0.85)*
0.99
(0.76-1.30)
1.47
(1.44-1.51)*

† Model adjusted for maternal race, maternal education, maternal age, maternal insurance, pre-pregnancy BMI, chronic hypertension, prediabetes, maternal  weight gain, previous cesarean section, induction of labor, augmentation of labor, birthweight, estimated gestational age, paternal age.  *p < 0.05

Table 2 highlights the association between paternal race/ethnicity and all measures of pregnancy outcome. Having a White father was associated with increased risk of NICU admissions (OR=1.003; 95% CI 1.01-1.04), requiring an assisted ventilation >6 hours following delivery (OR=1.25; 95%CI 1.21-1.29), Low Apgar score (OR=1.09; 95% CI 107-1.12), increased CS rate (OR=1.06; 95%CI 1.05-1.07) and maternal transfusion (OR=1.11; 95% 1.05-1.18). However, there was no statistically significant difference in the risk of neonatal mortality across the different races/ethnicities implying that the increased risk of neonatal adverse outcomes among White fathers does not translate into a higher risk of neonatal mortality among them.

Table 3: Paternal Education and Pregnancy Outcomes

Variables

NICU

AsVent

Apgar

MatTransf

InCare

CS  (Yes)

Mortality

Breast feeding

High School (Reference)

        

College

1.04
(1.03-1.06)*

0.99
(0.96-1.02)

0.85 

(0.67-1.07)

0.90 

(0.86-0.96)*

0.94 

(0.86-1.02)

1.12 

(1.11-1.13)*

0.95 

(0.87-1.03)

1.65 

(1.63-1.66)*

Advanced

1.10 

(1.06-1.14)*

0.93 

(0.86-1.00)

0.85 

(0.67-1.07)

0.99 

(0.86-1.14)*

0.85 

(0.67-1.07)

1.20 

(1.17-1.22)*

0.92 

(0.72-1.17)

2.01 

(1.95-2.07)*

† Model adjusted for maternal race, maternal education, maternal age, maternal insurance, pre-pregnancy BMI, chronic hypertension, prediabetes, maternal  weight gain, previous cesarean section, induction of labor, augmentation of labor, birthweight, estimated gestational age, paternal age.  *p < 0.05

Table 3 shows the association between paternal educational level and pregnancy outcome.

 

There is a positive association between increasing paternal educational level and uptake of breastfeeding and cesarean section rate. However, there was no association between paternal education and the risk of babies requiring assisted ventilation > 6hours after delivery or neonatal deaths.

Table 4: Interaction Between Paternal Race and Education Level and Pregnancy Outcome

VariablesNICUAsVentApgarMatTransfInCareCS (Yes)MortalityBreast feeding
Black High School (Reference)        
College

1.02

(1.00-1.05)

0.96

(0.91-1.01)

0.91

(0.87-0.94)*

0.92
(0.83-1.01)
1.02
(0.89-1.18)
1.09
(1.08-1.11)*
1.05
(0.92-1.18)
1.84
(1.81-1.87)*
Advanced

1.13

(1.06-1.20)*

0.94
(0.81-1.10)
0.91
(0.81-1.03)
0.98
(0.75-1.28)
0.79
(0.51-1.24)
1.18
(1.14-1.23)*
1.07
(0.76-1.52)
2.50
(2.37-2.64)*
         
White         
 High School1.03
(1.01-1.04)*
1.25
(1.21-1.29)*
1.09
(1.06-1.12)*
1.11
(1.04-1.18)*
1.06
(0.96-1.17)
1.07
(1.06-1.08)*
0.97
(0.89-1.07)
1.31
(1.30-1.32)*
College

1.05

(1.03-1.08)*

1.22

(1.17-1.29)*

1.02

(0.98-1.07)

1.02

(0.93-1.12)

0.93

(0.79-1.09)

1.11

(1.09-1.13)*

0.87

(0.75-1.02)

2.12

(2.09-2.15)*

Advanced

1.14

(1.08-1.21)*

1.17

(1.04-1.31)*

0.81

(0.93-0.99)*

1.23

(1.02-1.49)*

0.96

(0.68-1.36)

1.16

(1.13-1.20)*

0.87

(0.60-1.27)

2.46

(2.36-2.57)*

         
Hispanic        
High School

1.01

(0.99-1.02)

1.03

(1.00-1.07)

0.82

(0.79-0.84)*

1.02

(0.96-1.09)

1.07

(0.96-1.19)

0.92

(0.91-0.93)*

0.85

(0.77-0.94)*

1.81

(1.79-1.83)*

College

1.10

(1.08-1.14)*

1.10

(1.03-1.17)*

0.76

(0.71-0.81)*

0.90

(0.80-1.02)

0.96

(0.84-1.17)

1.23

(1.21-1.25)*

0.83

(0.68-1.01)

2.61

(2.55-2.67)*

Advanced

1.01

(0.93-1.10)

0.88

(0.72-1.07)

0.69

(0.57-0.83)*

0.65

(0.43-0.96)*

0.76

(0.82-1.39)

1.35

(1.28-1.41)*

0.47

(0.22-0.99)*

2.80

(2.59-3.03)*

         
Asian        
High School

0.89

(0.85-1.04)

0.82

(0.73-0.92)*

0.88

(0.81-0.98)*

0.89

(0.73-1.08)

0.82

(0.61-1.10)

0.79

(0.76-0.81)*

1.19

(0.89-1.61)

1.20

(1.17-1.24)*

College

0.96

(0.94-0.93)*

0.83

(0.68-1.00)

0.80

(0.69-0.95)*

0.81

(0.59-1.12)

0.67

(0.40-1.09)

0.86

(0.82-0.90)*

0.52

(0.27-1.04)

1.72

(1.63-1.81)*

Advanced

1.05

(0.91-1.21)

0.86

(0.60-1.26)

0.95

(0.71-1.28)

0.80

(0.41-1.54)

0.49

(0.16-1.54)

1.14

(1.04-1.24)*

0.55

(0.14-2.22)

2.24

(1.98-2.55)*

         
Mixed        
High School

1.01

(0.99-1.04)

1.15

(1.08-1.22)*

1.07

(1.01-1.12)*

1.05

(0.95-1.17)

0.95

(0.79-1.15)

0.95

(0.93-0.97)*

0.80

(0.66-0.96)*

 1.42

(1.40-1.44)*

College

0.94

(0.87-1.01)

1.15

(0.98-1.35)

1.00

(0.87-1.14)

0.95

(0.70-1.28)

1.08

(0.68-1.74)

0.95

(0.91-0.99)*

0.75

(0.43-1.30)

2.28

(2.16-2.41)*

Advanced0.97
(0.78-1.22)
1.12
(0.70-1.82)

0.93

(0.61-1.42)

1.66

(0.83-3.33)

2.00

(0.74-5.38)

0.96

(0.83-1.10)

0.99

(0.24-4.00)

3.03

(2.47-3.71)*

† Model adjusted for maternal race, maternal education, maternal age, maternal insurance, pre-pregnancy BMI, chronic hypertension, prediabetes, maternal  weight gain, previous cesarean section, induction of labor, augmentation of labor, birthweight, estimated gestational age, paternal age.  *p < 0.05

Table 4 is a sub-analysis showing the interaction between paternal race/ethnicities and educational level and how these interactions affect pregnancy outcomes across the different outcome measures.

 

Across all races/ethnicities, paternal education level correlated with an increased uptake of maternal breastfeeding and increased cesarean section rate. This finding is also factual for mothers implying a possible link to increased socioeconomic status. There is no association between paternal education level and neonatal mortality. Increasing paternal educational level is associated with improved Apgar score, especially among Whites, Hispanics, and Asians.

Discussion

Our study explored the interaction between paternal race and education level and how this interaction affects pregnancy outcomes. We utilized eight outcome measures to determine these interactions. The eight outcome measures were infant mortality, breastfeeding, 5 min Apgar score, neonatal unit admission, neonates receiving assisted ventilation for longer than 6 hours after birth, cesarean section, mothers requiring blood transfusion, and admission to the intensive care unit. The study demonstrated that increased paternal education is associated with increased cesarean sections rate and increased uptake of breastfeeding across all races and ethnicities. In addition, increased paternal education levels among paternity acknowledged births correlated with improved pregnancy outcomes, especially among Whites, Hispanics, and Asians.

 

A Californian study found out that women whose infants’ fathers had not completed college had significantly higher odds of preterm birth than women whose infants’ fathers were college graduates, even after adjusting for maternal education and family income.15 Thus, the study shows that paternal education may represent an important indicator of risk for preterm birth, reflecting social and economic factors not measured by maternal education or family income. Another Canadian study found out that low paternal education increases the risk of adverse birth outcomes, especially fetal and infant mortality, independently from maternal characteristics.16 While our study aligns with these findings, it is particularly unique because it focuses on many more pregnancy outcome measures.

 

Parker al17 further highlighted the association between paternal parameters and pregnancy outcome. They explored the association between paternal race/ethnicity and birth weight trends among interracial Black and White Infants. They found that mixed-race parents had a lower risk of low birth weight and very low birth weight than single-race births. Infants with a Black mother and a White father had lower odds of low birth weight than single-race infants. In comparison, infants with White mothers and Black fathers have a higher relative risk of low birth weight.

 

Migone et al. compared babies of four different subgroups to investigate the role of race/ethnicity in birth outcomes. The subgroups studied were both parents White (the reference group), mother White-father Black, mother Black-father White, and both parents Black. The study concluded that mean birthweight and gestational duration decreased from both parents White, mother White-father Black, mother Black-father White, and both parents Black while also showing an increase in low birth weight and preterm delivery18. In the present study, mothers of babies with mixed parentage had a lower cesarean section rate than the reference and tended to have a higher breastfeeding uptake. However, there was no significant difference compared to the reference in the other outcome measures.

 

When looking at cesarean section rates and levels of education, a study conducted in Italy found that mothers with a primary school degree had a 24% higher risk of undergoing a cesarean section than women who completed university education.19 The study also found that this relationship did not change regardless of their partner’s level of education. This study aligns with our finding of no association between paternal education and cesarean section rates. However, White fathers were more likely to have babies delivered via cesarean section than any other race/ethnicity. This finding may be due to a higher socioeconomic status, as many studies have associated a higher socioeconomic status with increased cesarean section rates. Some differences between our study and the Italian study may be due to methodology, sample sizes, and study designs.

 

The association between paternal race/ethnicities, education level, and maternal breastfeeding is interesting since breastfeeding has positively influenced neonatal health and well-being. Paternal involvement increases the likelihood that a woman will receive prenatal care in her first trimester by 40 percent and reduces a pregnant woman’s cigarette consumption by about 36 percent.20 The positive correlation between paternal education level and breastfeeding implies that this association will increase as the father’s education level increases. Expectant fathers can be influential advocates for breastfeeding by playing a critical role in encouraging a mother to breastfeed the newborn infant.20 Fathers who also accompanied the mother on prenatal visits have been more likely to engage in father-child activities later in the child’s life, hence improving bonding and better health outcome.21

 

According to a Swedish study, infants with fathers of a lower level of education who were receiving unemployment benefits or had a lower amount of disposable income were less likely to be breastfed between 2 and 12 months. In addition, infants with fathers who could not go on paternity leave during the infant’s first year of life were less likely to be breastfed at 2, 4, and 6 months.22 This study’s results show that the presence of supportive and involved fathers had a positive effect on the rates of breastfed infants.

 

In the present study, babies of White or Black fathers had the highest odds of a low 5min Apgar score. A retrospective review of the National Vital Statistic system birth data between 2009 and 2013 revealed that infants born to non-Hispanic Black parents were significantly less likely to have an APGAR score of 10 than those born to non-Hispanic White parents.20 Another study by Palatnik et al. demonstrated a significant association between paternal race/ethnicity and adverse pregnancy outcome. In the study, having a Hispanic father was associated with a lower risk of Apgar score <7 at 5 minutes and the need for neonatal assisted ventilation at >6 hours of life. Also, Black fathers had a slightly lower odd of babies requiring assisted ventilation at > 6 hours of life than Non-Hispanic White fathers.23

 

There is a need to explore the higher odds of adverse neonatal outcomes among Whites fathers. However, despite having a higher risk of NICU admission, poor Apgar score, and assisted ventilation, there was no difference in neonatal mortality rate between White fathers and any other races/ethnicities. A possible explanation for this finding may be that other factors are drivers of infant mortality rather than simply a father’s race/ethnicity.

Public Health Implications

While many studies have emphasized maternal risk factors for adverse pregnancy outcomes, very few studies have explored the role of fathers in pregnancy outcomes. In the present study, the authors found a significant association between pregnancy outcome and paternal characteristics such as race and education status, justifying the inclusion of these parameters in future studies and interventions that is aimed at improving pregnancy outcomes in the United States.

Strengths and Limitations

A significant strength is using data from the National vital statistics records. The American college of obstetrics and gynecology (ACOG) described the National vital statistics records as one of the oldest and most successful examples of intergovernmental data sharing in public health24. It provides reliable national representatives data on vital events such as births, deaths, marriages, divorces, and fetal deaths. In addition, the large sample size and the use of interaction term analysis increased our ability to detect differences when they exist. However, a limitation is the possibility of variability in the accuracy, completeness, and reliability of the data collected. To reduce this, the National Center for Health Statistics (NCHS) revised the standard forms for birth and death certificates and the fetal death report in 2003.24

Conclusion

The interaction between paternal race/ethnicities, educational level, and its association with pregnancy outcomes highlight the importance of including paternal parameters in algorithms designed to improve pregnancy outcomes in the United States. Therefore, it is vital to maximize these interactions for optimal pregnancy outcomes.

Author Contribution Statement

Dr. Oluwasegun Akinyemi designed the study, collected data, and analyzed the collected data.  Elleissy Nasef, Kindha, Drs. Christabel Ojieabu and  Christina Lipscombe contributed to the writing of the manuscript, while Dr.Oluwasegun Akinyemi, Christina Lipscombe, and Oluwakemi Adeola reviewed and edited the manuscript. All the authors approved the final draft.

Disclosure Statements

The authors have no conflicts of interest to disclose

References

  1. Meng Y, Groth SW. Fathers Count: The Impact of Paternal Risk Factors on Birth Outcomes. Maternal and Child Health Journal 2017 22:3. 2017;22(3):401-408. doi:10.1007/S10995-017-2407-8
  2. Liu C, Cnattingius S, Bergström M, Östberg V, Hjern A. Prenatal parental depression and preterm birth: a national cohort study. BJOG : An International Journal of Obstetrics & Gynaecology. 2016;123(12):1973-1982. doi:10.1111/1471-0528.13891
  3. ER Cheng, SL Rifas-Shiman, ME Perkins, et al. The Influence of Antenatal Partner Support on Pregnancy Outcomes. Journal of Women’s Health (2002). 2016;25(7):672-679. doi:10.1089/JWH.2015.5462
  4. A Reichenberg, R Gross, M Weiser, et al. Advancing paternal age and autism. Archives of general psychiatry. 2006;63(9):1026-1032. doi:10.1001/ARCHPSYC.63.9.1026
  5. Alio AP, Mbah AK Washington D. The impact of paternal involvement on feto-infant morbidity among Whites, Blacks, and Hispanics. Accessed November 3, 2021. https://reference.medscape.com/medline/abstract/19526333
  6. A.P. Alio, AK Mbah, JL Kornosky, et al. Assessing the impact of paternal involvement on racial/ethnic disparities in infant mortality rates. Journal of community health. 2011;36(1):63-68. doi:10.1007/S10900-010-9280-3
  7. Ngui E, Cortright A, Blair K. An Investigation of Paternity Status and Other Factors Associated with Racial and Ethnic Disparities in Birth Outcomes in Milwaukee, Wisconsin. Maternal and Child Health Journal 2008 13:4. 2008;13(4):467-478. doi:10.1007/S10995-008-0383-8
  8. Alio AP, Bond MJ, Padilla YC, Heidelbaugh JJ, Lu M, Parker WJ. Addressing policy barriers to paternal involvement during pregnancy. Maternal and Child Health Journal. 2011;15(4):425-430. doi:10.1007/S10995-011-0781-1
  9. Mincy R, Garfinkel I, Nepomnyaschy L. In-Hospital Paternity Establishment and Father Involvement in Fragile Families. Journal of Marriage and Family. 2005;67(3):611-626. doi:10.1111/J.1741-3737.2005.00157.X
  10. Yargawa J, Leonardi-Bee J. Male involvement and maternal health outcomes: systematic review and meta-analysis. Journal of Epidemiology and Community Health. 1979;69(6):604-612.
  11. Suandi D, Williams P, Bhattacharya S. Does involving male partners in antenatal care improve healthcare utilization? Systematic review and meta-analysis of the published literature from low- And middle-income countries. International Health. 2020;12(5):484-498. doi:10.1093/INT HEALTH/IHZ073
  12. L Lindberg, I Maddow-Zimet, K Kosi, A Lincoln. Pregnancy intentions and maternal and child health: an analysis of longitudinal data in Oklahoma. Maternal and Child Health Journal. 2015;19(5):1087-1096. doi:10.1007/S10995-014-1609-6
  13. BE Hamilton, DL Hoyert, JA Martin, DM Strobino, B G. Annual summary of vital statistics: 2010-2011. Pediatrics. 2013;131(3):548-558. doi:10.1542/PEDS.2012-3769
  14. NVSS. NVSS – National Vital Statistics System Homepage. Accessed November 3, 2021. https://www.cdc.gov/nchs/nvss/index.htm
  15. Blumenshine PM, Egerter SA, Libet ML, Braveman PA. Father’s education: An independent marker of risk for preterm birth. Maternal and Child Health Journal. 2011;15(1):60-67. doi:10.1007/S10995-009-0559-X
  16. Shapiro GD et al. Paternal education and adverse birth outcomes in Canada on JSTOR. Accessed November 3, 2021. https://www.jstor.org/stable/44133849?seq=1#metadata_info_tab_contents
  17. J.D. P. Birth weight trends among interracial black and white infants. Epidemiology (Cambridge, Mass). 2000;11(3):242-248. doi:10.1097/00001648-200005000-00003
  18. A Migone, I. Emanuel, B Mueller, J Daling, RE Little. Gestational duration and birthweight in white, black, and mixed-race babies. Pediatric and perinatal epidemiology. 1991;5(4):378-391. doi:10.1111/J.1365-3016.1991.TB00724.X
  19. Cesaroni G, Forastiere F, Perucci CA. Are Cesarean Deliveries More Likely for Poorly Educated Parents? A Brief Report from Italy. Birth. 2008;35(3):241-244. doi:10.1111/J.1523-536X.2008.00245.X
  20. Grunebaum A, Ali M. Influence of Parental Race on Apgar Scores [19R]. Obstetrics & Gynecology. 2016;127(Supplement 1):152S. doi:10.1097/01.AOG.0000483607.08740.40
  21. Yogman M, Garfield CF, HEALTH COPAOCAF. Fathers’ Roles in the Care and Development of Their Children: The Role of Pediatricians. Pediatrics. 2016;138(1). doi:10.1542/PEDS.2016-1128
  22. R Flacking, F Dykes, U Ewald. The influence of fathers’ socioeconomic status and paternity leave on breastfeeding duration: a population-based cohort study. Scandinavian journal of public health. 2010;38(4):337-343. doi:10.1177/1403494810362002
  23. A Palatnik, E Garacci, RJ Walker, MN Ozieh, JS Williams, LE Egede. The Association of Paternal Race and Ethnicity with Adverse Pregnancy Outcomes in a Contemporary U.S. Cohort. American Journal of Perinatology. 2019;38(7):698-706. doi:10.1055/S-0039-3400995
  24. The Importance of Vital Records and Statistics for the Obstetrician–Gynecologist | ACOG. Accessed January 12, 2022. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/08/the-importance-of-vital-records-and-statistics-for-the-obstetriciangynecologist

 

About the Authors

Dr. Oluwasegun Akinyemi

Dr. Oluwasegun Akinyemi received his Bachelor of Medicine/ Bachelor of Surgery degree from Nigeria’s prestigious Obafemi Awolowo University. He completed a residency training in Obstetrics and Gynecology, becoming a fellow of the National Postgraduate Medical College of Nigeria in 2017. He joined the Clive. O. Callender, M.D., Howard-Harvard Outcomes Research Center as a research associate in 2020 after completing a Master of Science in Public Health program at the Western Illinois University, Illinois, USA. Dr. Akinyemi’s research interests include exploring disparities in access and quality of care related to pregnancy outcomes, the role of social determinants of health and chronic conditions such as obesity, diabetes, and hypertension on pregnancy outcomes, and how these factors affect women’s health. He is interested in highlighting these disparities and passionate about designing interventional studies tailored at improving health outcomes in the United States.  

Dr. Christabel Ojieabu

Dr. Christabel Ojieabu received her Bachelor of Medicine/ Bachelor of Surgery degree from Olabisi Onabanjo University, Ago-Iwoye in Nigeria, where she finished as the best graduating student. She completed her internship at Federal Medical Centre, Abeokuta, one of Nigeria’s largest tertiary health centers, and is currently in her final months of National Youth Service at Olabisi Onabanjo University Teaching Hospital.Her research interests include radiological findings as they relate to various diseases, effects of nutrition on education, and female reproductive and adolescent health.

Kindha Elleissy Nasef

Kindha Elleissy Nasef is a third-year medical student at Howard University College of Medicine. She obtained her Bachelor of Science in Human Health, Performance, and Leisure with a concentration in Sports Medicine and a Chemistry minor. Nasef has then gone on to pursue a career in medicine with the goal of becoming a surgeon. She is passionate about health disparities which can be explained by her upbringing in Cairo, Egypt. She is very interested in exploring the relationship between different aspects of the healthcare system and how they affect patient outcomes and hopes to become a trauma surgeon one day. 

Dr. Christina Lipscombe

Dr. Christina Lipscombe received her Doctor of Osteopathic Medical Degree from Philadelphia College of Medicine in Philadelphia, PA. She is currently in the third year of her OBGYN residency program at Howard University Hospital. Dr. Lipscombe is interesting in applying for and completing a Minimally Invasive Gynecologic Surgery Fellowship. Her research interest includes health care disparities within minority populations and how this affects pregnancy outcomes. She is also interested in promoting and advancing minimally invasive gynecology surgery to all women. Lastly, shoe wishes to further explore endometriosis and the discrepancy of the prevalence of diagnosis in the African American population. 

Oluwakemi (Kemi) Lois Adeola

Oluwakemi (Kemi) Lois Adeola is a Registered Dietitian and a Clinical Assistant Professor in the Department of Nutritional Sciences at Howard University. She obtained her undergraduate degree in biochemistry (2007) from the University of Ilorin, Nigeria, her master’s degree in Nutrition and Dietetics (2015) from the University of the District of Columbia, Washington DC, and her Ph.D. in Nutritional Sciences (2020) from Howard University, Washington DC. She teaches Medical Nutrition Therapy and Nutrition Care Management and facilitates clinical rotations of the dietetics students. She completed her dietetic internship through the coordinated program in dietetics at Howard University and worked as a clinical dietitian in an acute care setting. She served as an adjunct professor at the University of the District of Columbia Community College. Her research interest is the effects of nutrition support on malnutrition and inflammatory biomarkers. Kemi is also interested in bioactive food components and the role of diet and lifestyle in preventing inflammation and chronic diseases.

Print