Background:
Mississippi has a historical and rising prevalence of chronic disease and infant mortality. Identification of mothers at risk for negative birth outcomes could provide valuable information for health intervention planning and policy development.

Objectives:
1. To investigate the impact of selected maternal chronic medical conditions, race, and age on preterm birth (PTB), low birth weight (LBW), and infant mortality.
2. To establish baseline research data for preconception health and education programs.

Methods:
A retrospective cohort analysis of birth certificates linked with infant deaths was performed. Analysis included the 1999-2003 Mississippi birth cohort including 202,931 singleton infants live-born to African American and white women. Dependent variables were PTB, LBW, and infant mortality. Percentage of each dependent variable by maternal age, race and selected maternal chronic medical condition was investigated using logistic regression analysis.

Results:
PTB, LBW, and infant mortality were more prevalent among African American women, very young women (≤ 15 years), and women with certain chronic medical conditions. Among White mothers, maternal chronic hypertension was a significant factor associated with PTB (p < 0.0001) and LBW (p < 0.0001); maternal diabetes was a significant factor associated with PTB (p < 0.0001) and infant mortality (p < 0.0001). Among African-American mothers, maternal cardiac disease was a significant factor associated with both PTB (p = 0.018) and LBW (p = 0.0251); maternal chronic hypertension was a significant factor associated with LBW (p < 0.0001) and infant mortality (p = 0.0427); maternal diabetes was significant for PTB (p < 0.0004).

Conclusion and implications for practice:
Maternal chronic hypertension and diabetes were significantly associated with negative birth outcomes regardless of maternal race. Maternal cardiac disease was only significantly associated with African-American mothers on PTB and LBW in Mississippi. The study underscores the importance of increasing access to preconception care and training for women's healthcare providers in recognizing and understanding the effects of chronic disease in women. The study accents the need for preventive healthcare in reducing African American disparities in infant and adult mortality and morbidity, a particularly serious and growing problem in Mississippi. Policy development geared at improving maternal health could improve outcomes for Mississippi infants and their families.