The purpose of this study was to assess racial variations in pregnancy outcomes and the impact of prenatal care utilization on racial patterns in maturity at delivery and maturity-specific neonatal mortality. Data for this study were obtained from live birth-infant death cohort files from North Carolina and South Carolina for 1978 through 1982.

Overall risk status of the mother was determined by a combination of factors (marital status, maternal education, combined maternal age and the number of previous pregnancies, complications of pregnancy, and the number of previous fetal deaths or pregnancy termination), and high-risk status was assigned to mothers with at least one risk factor. For blacks, the proportion of all births that were to high-risk mothers was approximately twice that for whites. The proportions with low birth weight babies, pre-term births, and neonatal mortality rates were also higher for blacks than whites.

More black mothers had no prenatal care (2% of black mothers vs. 0.6% of white mothers) or inadequate prenatal care (11.7% of black mothers vs. 3.9% of white mothers). Conversely, more of the white mothers had intensive prenatal care (9% of white mothers vs. 5% of black mothers) or adequate prenatal care (66.3% of white mothers vs. 43.4% of black mothers). Overall, whites had higher gestational ages than blacks (by an average of five days).

Among both black and white mothers with either high or low risk, the mean birth weight increased and the percentage of low birth weight babies decreased with increased prenatal care utilization. Similar patterns were found for the mean gestational age and for percentage pre-term.

For birth weights below 3500 grams, blacks experienced lower mortality rates than whites regardless of the level of prenatal care utilization. For higher birth weights, whites experienced lower mortality rates. Similar patterns were observed when births were categorized by birth weight and gestational ages together.

The authors conclude that, although prenatal care and risk status predicted maturity, within equivalent prenatal care utilization and risk categories there are distinct racial differences in both maturity indices – birth weight and gestational age distribution. "These data support the proposition that the adequate attainment of prenatal care may not be sufficient to eliminate excess levels of poor pregnancy outcomes in blacks." This study is limited by its lack of data on the treating hospital, medical factors, and alcohol and cigarette use.