The first-year mortality rates of singleton term infants of US-born and foreign-born women: the effect of paternal acknowledgment.

OBJECTIVE: To determine the whether a greater percentage of term infant deaths among US-born (versus foreign-born) women is attributable to paternal non-acknowledgement.

STUDY DESIGN: Using a cross-sectional population-based design, stratified and multivariable binomial regression analyses were performed on a subset of the 2017 National Center for Health Statistics linked live birth-infant death cohort dataset of singleton, term (37-42 weeks) infants of US-born (N=2,127,243) and foreign-born (N=334,664) women.

RESULTS: Infants of US-born women had a prevalence of paternal non-acknowledgement of 11.3% versus 7.5% for foreign-born women, p < 0.001. The infant mortality rate of term births to US-born women with paternal non-acknowledgment equaled 5.0/1,000 versus 2.0/1,000 for those with paternal acknowledgment; RR = 2.47 (2.31, 2.86). The IMR of term births to foreign-born women with paternal non-acknowledgment equaled 2.5/1,000 versus 1.6/1,000 for those with paternal acknowledgment, RR = 1.61 (1.24, 2.10). The adjusted (controlling for selected covariates) RR of first-year mortality of term births among US-born and foreign-born women with non-acknowledged (versus acknowledged) fathers equaled 1.43 (1.33, 1.54) and 1.38 (1.04, 1.84), respectively. The population attributable risk percent of term infant deaths for paternal non-acknowledgement among US-born and foreign-born women equaled 4.9% (246 deaths) and 2.8% (15 deaths), respectively.

CONCLUSIONS: Paternal non-acknowledgement is associated with a 40% higher IMR among term births to US-born and foreign-born women; however, a greater proportion of first-year deaths among term births to US-born (versus foreign-born) women is attributable to paternal non-acknowledgment. These findings highlight the importance of father's involvement to term infant outcome.