Background Preterm birth (PTB) is a significant challenge in the U.S., disproportionately affecting Black women, especially in Cuyahoga County, Ohio, where rates exceed national averages. In 2020, PTB rates were 11.4% overall and 15.1% among Black women, compared to national averages of 10.1% and 14.4% respectively. These disparities persist across socioeconomic groups, highlighting the need for further investigation into specific contributing factors for Black women. This study aims to characterize risk factors associated with PTB among Black women in Cuyahoga County using data from singleton preterm births in 2021.

Methods This descriptive cohort study involved non-Hispanic Black women aged 18 or older who delivered prematurely at two Cleveland Clinic hospitals. PTB was defined as delivery before 37 weeks gestation, excluding patients with late transfers of obstetric care or incomplete medical records. Demographic, medical, and obstetric variables were extracted from electronic medical records and analyzed using REDCap.

Results A total of 141 patients met inclusion criteria, with a mean age of 28.3 (±5.7) years and a mean pre-gravid BMI of 32.1 (±10.1). Most participants were single (78.0%, n = 110) and insured (97.9%, n = 138). The median household income was $45,087 31690.0, 58714.0. 73.8% (104) of patients had at least one underlying health condition, notably hypertension (23.4%, n = 33), anemia (26.2%, n = 37), and psychiatric disorders (30.5%, n = 43), including depression and anxiety. 24.8% (25) reported tobacco use.

In regards to obstetric history, 30.5% (43) had a previous PTB, and over half (55.3%, n = 78) had complications in a prior pregnancy. During the index pregnancy, the mean gestational age at delivery was 35.4 33.2, 36.4 weeks. Prenatal care began at 2.0 months gestation on average, with an average of 14 prenatal visits. Most patients (70.2%, n = 99) had gestational comorbidities, notably pre-eclampsia or eclampsia (29.1%, n = 41), anemia (22.0%, n = 31), gestational diabetes (12.1%, n = 17), and gestational hypertension (9.2%, n = 13). High percentages (83.7%, n = 118) completed recommended ultrasound screenings.

Conclusion The study highlights that social support, socioeconomic status, and underlying health conditions continue to be key risk factors associated with PTB among Black women. The COVID-19 pandemic may have exacerbated these vulnerabilities. Notably, lack of insurance and inadequate prenatal care did not emerge as significant risks in this cohort.