Chapter

Black–White Disparities in Birth Outcomes: Is Racism-Related Stress a Missing Piece of the Puzzle?

DOI: 10.1007/978-1-4419-9616-9_10

ABSTRACT For decades, large disparities in birth outcomes have been observed between babies born to African- American (black) women
and those born to European-American (white) women. Adverse birth outcomes – being born “too early” (premature or preterm birth,
before 37 completed weeks of pregnancy) or “too small” (low birth weight, less than 5½ pounds) – are powerful predictors not
only of infant survival, but also of child health, development, and serious disability (Institute of Medicine, 2007). Recent
research reveals that low birth weight and premature birth also are strong predictors of chronic disease in adulthood, including
cardiovascular disease and diabetes, which are major causes of premature mortality (Barker, 2006; Phillips, Jones, & Goulden,
2006; Whincup et al., 2008). As shown in Figs. 10.1 and 10.2, the disparities generally have been persistent, until recently
when relative disparities began to narrow somewhat, for undesirable reasons: the rates of both preterm birth (PTB) and low
birth weight (LBW) worsened among white women, with little (PTB) or no (LBW) improvement among black women. (For simplicity,
throughout this chapter “black” and “white” are used to refer only to non-Hispanic women.)

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    Social Science [?] Medicine 03/2012; 74(5):665-7. DOI:10.1016/j.socscimed.2011.12.009 · 2.56 Impact Factor
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    ABSTRACT: Objectives. We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB). Methods. We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables. Results. Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups. Conclusions. Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage. (Am J Public Health. Published online ahead of print September 11, 2014: e1-e9. doi:10.2105/AJPH.2014.302008).
    American Journal of Public Health 09/2014; 105(4):e1-e9. DOI:10.2105/AJPH.2014.302008 · 4.23 Impact Factor
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    ABSTRACT: Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2))] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n = 6,849 pregnancies; range 1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p value = 0.08). Normal weight Black [risk ratio (RR) 1.34, 95 % confidence interval (CI) 1.18, 1.52] and Hispanic women (RR 1.33, 95 % CI 1.15, 1.54) and underweight Black women (RR 1.38, 95 % CI 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG.
    Maternal and Child Health Journal 02/2015; DOI:10.1007/s10995-015-1682-5 · 2.24 Impact Factor

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