Black-White Differences in Chronic Stress Exposures to Predict Preterm Birth: Interpretable, Race/Ethnicity-Specific Machine Learning Models.

We developed Multivariate Adaptive Regression Splines (MARS) machine learning models of chronic stressors using the Pregnancy Risk Assessment Monitoring System data (2012-2017) to predict preterm birth (PTB) more accurately and identify chronic stressors driving PTB among non-Hispanic (N-H) Black and N-H White pregnant women in the U.S. We trained the MARS models using 5-fold cross-validation, whose performance was evaluated with AUC. We computed variable importance for PTB prediction. Our models showed high accuracy (AUC: 0.754-0.765). The number of prenatal care visits, premature rupture of membrane, and medical conditions were the most important variables in predicting PTB across the populations. Chronic stressors (e.g., low maternal education and violence) and their correlates were pivotal for PTB prediction only for N-H Black women. Interpretable, race/ethnicity-specific MARS models can predict PTB accurately and explain the most impactful life stressors and their magnitude of effect on PTB risk among N-H Black and N-H White women.