Maternal Education–Related Patterns of Early Preterm Birth Rates: The Impact of Paternal Acknowledgment

OBJECTIVE: To determine whether paternal acknowledgment modifies the relationship between women’s education attainment and race/ethnic group–specific early (<34 weeks) preterm birth rates. DESIGN: Cross-sectional population-based design. SETTING: 2019 US natality files. PARTICIPANTS: Singleton births to non-Latina White (n=1,617,932), African American (n=414,214), and Latina (n=335,912) US-born women. METHODS: Stratified and multivariable log binomial regression analyses were performed. MAIN OUTCOME MEASURE: Early preterm rates. RESULTS: The percentage of births with non-acknowledged fathers ranged from 1% for college-graduated non-Latina White women to 51% for African American women who did not complete high school. Among births with non-acknowledged fathers, we observed that 1) college-graduated non-Latina White women had an early preterm birth rate of 2.4% versus 4.0% for those who did not complete high school (adjusted [controlling for maternal risk status] RR [95% CI]=0.6 [0.5-0.7]); 2) college-graduated African American women had an early preterm birth rate comparable to their peers who did not complete high school: (5.6% vs 4.8%; adjusted RR=0.9 [0.8-1.0]); and 3) college-graduated Latina women had an early preterm birth rate similar to their counterparts who did not complete high school [3.7% vs 3.0%; adjusted RR=0.9 [0.7-1.3]). Among births with acknowledged (unmarried or married) fathers, race/ethnic group–specific early preterm birth rates decreased as maternal education attainment rose. CONCLUSIONS: The protective effect of non-Latina White women’s college education attainment on early preterm birth rates exists regardless of paternal acknowledgment. Intriguingly, African American and Latina women’s college education attainment is only associated with a decreased early preterm birth rates among births with acknowledged fathers.