To investigate the contribution of SGA (birth weight<10th percentile) and gestational age (GA) on the black-white disparity in fetal deaths, we utilized NCHS records of US live births (LB) and fetal deaths (FD) in 1986. Data analysis included calculation of fetal death rates (FDR), odds ratios(OR), and 95% confidence intervals (CI), using chi square and multiple logistic regression models. For GA-specific analyses, the FDR was considered to be the quotient of all FD at the index GA, divided by the sum of all LB and FD occurring at that GA or later.

The overall FDR (number of FD per 1000 LB) in black singletons was 7.5 per 1000 LB, compared to 4.2 per 1000 LB in whites (OR=1.8; CI=1.7, 1.9). SGA was more common in blacks than in whites among LB (OR=2.1; CI=2.08, 2.12), but only slightly more prevalent in blacks among FD (OR=1.2; CI=1.1, 1.3). SGA prevalence increased significantly between 24 and 40 weeks' gestation in both racial groups. FD was significantly associated with SGA in blacks (OR=5.0; CI=4.7, 5.2) and in whites (OR=8.8; CI=8.5, 9.1). In GA-specific logistic models adjusted for maternal age and prenatal care, black race was significantly associated with FD at each GA to term, and this excess black risk persisted after controlling for SGA. The risk of FD associated with black race was highest at 24 weeks (OR=1.77; CI=1.63, 1.92) and lowest at term(OR=1.22; CI=1.13, 1.31).

We conclude that SGA, an important risk factor for fetal death, accounts for a portion of the excess risk of fetal death in blacks. However, the black-white disparity in fetal deaths persists after controlling for SGA, and this disparity is greater in preterm than in term gestation pregnancies.