| Bower et al. (2018) [51] |
12 states, USA |
Non-Hispanic Black mothers (N = 11,582). |
Cross-sectional |
|
|
|
Overall, 14.2% (95% CI, 13.3–15.2) of participants had experienced racism in the past year. Controlling for all covariates, women who had experienced racism in the past year were 1.29 (95% CI, 1.04–1.59) more likely than women who had not experienced racism to give birth preterm. Moderation analyses indicated that experience of racism was positively associated with odds of preterm birth for women who received intermediate (AOR, 2.03, 95% CI, 1.04–3.97) or adequate prenatal care (AOR, 1.57, 95% CI, 0.95–2.59). There was no association for inadequate or adequate-plus prenatal care.
|
Moderate |
| Carty et al. (2011) [43] |
Saginaw County, MI, USA |
Mothers (N = 629, Black n = 407, White n = 222). |
Cross-sectional |
Frequency of experiences of past-year racism (Everyday Discrimination Scale) Perceived group-impact racism (Racism and Life Experiences Scale) Racism-related stress (Racism and Life Experiences scale) Emotional reactions to racism (Racism-related Experiences Scale).
|
Age Parity Education Self-identified race Beliefs and experiences of racism Self-reported physical/mental health Smoking Pregnancy and birth experiences.
|
|
Frequency of racial discrimination was positively associated with likelihood of smoking and negatively correlated with mental and physical health. Emotional responses to racism was the only racism measure that predicted pregnancy or birth outcome. Experiencing racism that elicited emotional reactions increased the odds of low birth weight by 24% (OR = 1.24, 95% CI, 0.93–1.48). This effect attenuated in the fully-adjusted model, rendering the statistical effect marginally significant.
|
Moderate |
| Christian et al. (2012) [33] |
OH, USA |
Pregnant women (N = 56, Black n = 38, White n = 18). |
Longitudinal |
|
|
|
Black women exhibited substantially higher levels of IgG antibody titers than White women during each trimester and postpartum: 1st trimester, m = 3.13 (95% CI, 3.02–3.26) vs. m = 2.62 (95% CI, 2.45–2.80), respectively. 2nd trimester, m = 3.13 (95% CI, 3.01–3.25) vs. m = 2.62 (95% CI, 2.47–2.81), respectively. 3rd trimester, m = 3.09 (95% CI, 2.97–3.20) vs. m = 2.64 (2.47–2.81), respectively. Postpartum, m = 3.14 (95% CI, 3.02–3.26) vs. m = 2.66 (95% CI, 2.48–2.83), respectively. Black women who reported high discrimination showed higher EBV VCA IgG antibody titers than Black women who reported low discrimination in the first (p = 0.03) and second trimesters (p = 0.04) as well as postpartum (p = 0.06). Black women who reported high discrimination showed higher EBV VCA IgG antibody titers than White women in all trimesters and postpartum (p < 0.001)
|
Moderate |
| Collins et al. (2000) [35] |
Chicago, IL, USA |
Black women (N = 85). Mothers of very-low-birth-weight (VLBW) children (n = 25) vs. mothers of healthy-weight children (n = 60). |
Case-control study. |
|
|
|
The odds of giving birth to VLBW children for women who reported racial discrimination vs. those who did not was OR = 4.4 (95% CI, 1.1–18) for mothers with two or more of the following risk factors: high parity, poor pre-natal care, lacking social support, tobacco use, alcohol, or illicit drug use.
|
Moderate |
| Collins et al. (2004) [34] |
Chicago, IL, USA |
Black women (N = 312). Mothers of VLBW children (n = 104) vs. mothers of normal-weight children (n = 208). |
Case-control study. |
Pervasiveness of lifetime/pregnancy exposure to interpersonal racial discrimination (Experiences of Discrimination Scale), Frequency of experienced interpersonal racial discrimination at place of employment in past year (Perceived Racism Scale).
|
Age Education Marital status Parity Prenatal care Gestational age Smoking Alcohol use.
|
|
Exposure to interpersonal racial discrimination during pregnancy did not appear to impact on birth weight. Lifetime exposure to racial discrimination significantly predicted VLBW. Having experienced this type of discrimination in at least one of five domains (work, getting a job, school, getting medical care, patronizing a restaurant) increased the odds of VLBW by 1.9 (95% CI, 1.2–3.1). Being the target of discrimination in three or more domains increased the odds of VLBW to 3.2 (95% CI, 1.5–6.6). This suggests a dose-response relationship. This relationship was stronger for women who had other risk factors (alcohol use, poor pre-natal care, low SES)
|
Moderate |
| Daiely et al. (2009) [2] |
Northern CA, USA |
Pregnant Black women (N = 108) |
Prospective cohort study. |
|
|
|
Overall, 86% of participants reported experiences of general discrimination, typically race-, gender-, or age-based discrimination). Women who reported discrimination due to religion were more likely than women who reported no such discrimination to have infants with lower birth weight (t = 2.39, p = 0.02).
|
Moderate |
| Daniels et al. (In press) [44] |
San Francisco Bay Area, CA, USA |
Black women (N = 173) |
Cross-sectional |
|
Parity Income Education Employment status Marital status.
|
|
For each one-unit increase in adolescent direct racial discrimination, there was a 48% increase in odds for preterm labor (OR = 1.48, 95% CI, 1.00–2.19). For each one-unit increase in childhood vicarious racial discrimination, there was a 45% increase in odds for preterm labor (OR = 1.45, 95% CI, 1.01–2.09). Adult direct or vicarious racial discrimination was not statistically associated with preterm birth.
|
Moderate |
| Dixon et al. (2012) [3] |
Eastern MA, USA |
Mother-infant pairs (N = 539; Black n = 294, Hispanic n = 127, Asian n = 110, Other n = 8) in Eastern MA. |
Prospective cohort study. |
|
|
Birth weight for gestational age Age- and sex-specific weight for 6-month-old Age- and sex-specific BMI for 3-year-old.
|
Approx. 33% of participants had not experienced racial discrimination. However, 33% had experienced racial discrimination in 1–2 life domains, and another 35% had experienced racial discrimination in 3 or more domains. Adjusting for all covariates, children of women who had experienced discrimination in >2 life domains had infants with lower birth weight for gestational age (β = −0.25, 95% CI, −0.45 to −0.04), lower weight-for-age at six months (β = −0.34, 95% CI, −0.65 to −0.03), and lower BMI-for-age at three years (β = −0.33, 95% CI, −0.66 to 0.00) than children of women who had not experienced discrimination. Children of women who had experienced discrimination in 1–2 domains were generally intermediate in size and weight, suggesting a dose-response relationship.
|
Strong |
| Dole et al. (2003) [30] |
Central NC, USA |
Pregnant women (N = 1962; Black n = 707, White n = 1134, other n = 121). |
Prospective cohort study. |
|
Education Age Parity Marital status Height BMI during pregnancy % poverty index Bacterial vaginosis infection Alcohol use during pregnancy Smoking during months 1–6 of pregnancy Social support Pregnancy-related anxiety Perceived neighborhood safety Stressful life events.
|
|
There was an increased risk of preterm birth among Black women who had experienced racial discrimination (RR = 1.4, 95% CI, 1.0–2.0). Gender discrimination was not statistically associated with preterm birth.
|
Strong |
| Dole et al. (2004) [31] |
Central NC, USA |
Pregnant women (N = 1898; Black n = 727, White n = 1174). |
Prospective cohort study. |
|
|
|
There was an increased risk of preterm birth for Black women who had experienced higher (vs. lower) levels of racial discrimination (RR = 1.8, 95% CI, 1.1–2.9). Gender discrimination predicted spontaneous preterm birth (as opposed to induced preterm) for Black women (RR = 2.1, 95% CI, 1.0–4.3).
|
Strong |
| Dominguez et al. (2008) [4] |
Los Angeles, CA, USA |
Pregnant women (N = 124; Black n = 51, White n = 73). |
Prospective, repeated-measures observational study. |
Pervasiveness and frequency of direct and vicarious racial discrimination in lifetime, adulthood, adolescence, childhood (Experiences of Discrimination Scale).
|
21 medical risk conditions, including medical history, pregnancy history, and current pregnancy. Pregnancy weight, Age, Cohabitation with father, Employment status, Race, SES, Education, Income, Income incongruity, Pregnancy stress, Gestational age, General stress.
|
|
For Black women, each unit increase in lifetime perceived racism was associated with a 39.59 g decrease in birth weight, ΔR2 = 0.02, β = −0.17, p < 0.05. Accounting for life stage racism, childhood-vicarious racism emerged as the main driver of this effect with each unit increase being associated with a 167.85 g decrease in birth weight (β = −0.25, p < 0.01). Black women were more likely to give birth to children of low birth weight than White women (280.83 g difference between Black and White babies). In a fully adjusted mediation model, childhood-vicarious racism was found to mediate this effect (ΔR2 = 0.02, p < 0.05; Sobel test = −1.74, p < 0.05, one-tailed).
|
Moderate |
| Earnshaw et al. (2013) [45] |
New York, NY, USA |
Pregnant Black/Latina women (N = 420, Black n = 158, Latina n = 262). |
Prospective cohort study. |
|
Age, Race/ethnicity, Birth country, Education, Relationship status, Pregnancy history, Health behavior, Nutrition, Exercise, Depression, Gestational age, Prenatal distress.
|
|
Everyday discrimination was associated with greater odds of low birth weight, OR = 2.78, p < 0.05. The association between everyday discrimination and birth weight was mediated by increases in depressive symptoms during pregnancy (β = −0.04, p < 0.01), such that for every one-point increase in everyday discrimination, birth weight decreased by 49 g (β = −49.27, p < 0.05).
|
Strong |
| Gillespie and Anderson (2018) [36] |
OH, USA |
Pregnant Black women (N = 96). |
Prospective cohort study. |
|
|
|
There were no effects of discrimination on gestational age at birth. There was no main effect of discrimination on maternal cortisol levels. However, compared to women in discrimination tertile 1 (no discrimination, n = 46), women in tertile 2 (medium discrimination), who internalized experiences of discrimination (n = 19) exhibited higher levels of maternal cortisol (b = 0.68, p = 0.001). Racial discrimination correlated negatively with leukocyte glucocorticoid sensitivity. Each ng/mL increase in maternal cortisol level predicted birth 0.15 days earlier among women in discrimination tertile 1 vs. tertile 2 (medium) and 3 (high, n = 26).
|
Moderate |
| Giurgescu et al. (2012) [37] |
Chicago, IL, USA |
Black mothers (N = 72). |
Descriptive correlational comparative study. |
|
Age, Marital status, Education, Income, Gestational age, Medical history, Psychological distress past month, Neighborhood social disorder, Perceived neighborhood physical disorder, Perceived neighborhood crime, Objective neighborhood environment.
|
|
Participants reported low levels of racial discrimination. No statistically significant relationship between racial discrimination and gestational age at birth was found. Racial discrimination predicted psychological distress (β = 0.524, p < 0.01).
|
Weak |
| Grobman et al. (2018) [38] |
Nine states, USA |
Pregnant women (N = 9470; Black n = 1307, White n = 5721, Hispanic n = 1586, Asian n = 379, other n = 477) |
Cross-sectional study. |
|
Maternal age, BMI, Smoking, Medical co-morbidities, Stress, Anxiety, Social Support, Postnatal depression, Resilience.
|
|
Black women were more likely than White women to give birth preterm (12.3% vs. 8.1%, OR = 1.6, 95% CI, 1.32–1.93), have low-birth weight children (17.2% vs. 8.6%, OR = 2.20, 95% CI, 1.86–2.62), and to have hypertensive disease of pregnancy (16.7 vs. 13.4, OR = 1.3, 95% CI, 1.3–1.10). None of the predictors, other than social support, accounted for statistically significant portions of variance in the discrepancy between Black and White women’s pregnancy outcomes.
|
Moderate |
| Hilmert et al. (2014) [39] |
Los Angeles and Orange counties, CA, USA |
Pregnant Black women (N = 39). |
Prospective cohort study. |
|
|
|
Adjusting for confounding variables, results indicated a marginally significant inverse relationship between exposure to any racial discrimination and birth weight (β = −0.27, p < 0.10). Direct exposure to racial discrimination in adulthood was significantly and inversely associated with birth weight (β = −0.26, p < 0.05). Change in diastolic blood pressure during pregnancy and childhood vicarious and direct racial discrimination interacted to predict lower birth weight (β = −0.25, ΔR2 = 0.04, p < 0.05; β = −0.22, ΔR2 = 0.03, p < 0.10, respectively). For Black women who had experienced childhood vicarious racial discrimination in at least two life domains, birth weight declined by 19.98 g for every 1 mm Hg increase in diastolic blood pressure (B = −160.65, p < 0.05).
|
Moderate |
| Lespinasse et al. (2004) [40] |
Chicago, IL, USA |
Black mothers of very-low-birth-weight infants (<1500 g) (n = 104) vs. healthy weight infants (approx. 2500 g) (n = 208). |
Case-control study. |
|
Maternal age, Marital status, Cohabitation status, Pre-natal care, Parity, Smoking, Alcohol use, Income, Desirable/undesirable pregnancy, Companion in delivery room, Stressful life events, Social environment, Religion.
|
|
Experienced racial discrimination in one or more life domains was associated with a two-fold increase in the odds of very low birth weight (OR = 1.9, 95% CI, 1.2–3.0). Experienced racial discrimination in three or more life domains was associated with a near three-fold increase in the odds of very low birth weight (OR = 2.7, 95% CI, 1.3–5.4). Lack of social support was associated with a more than three-fold increase in the odds of having a baby with very low birth weight.
|
Strong |
| Mendez et al. (2014) [52] |
Philadelphia, PA, USA |
Pregnant women (N = 3462). |
Cross-sectional study. |
|
Maternal race/ethnicity, Age at time of study, Income, Education, Marital status, Smoking, Alcohol use, Parity, Housing tenure/home ownership, Years lived in the neighborhood. Residential segregation, Neighborhood redlining, Stress, Neighborhood quality.
|
|
|
Weak |
| Misra et al. (2010) [47] |
Baltimore, MD, USA |
Pregnant Black women (N = 832). |
Hybrid retrospective and prospective cohort study. |
Frequency of lifetime exposure to racism (Racism and Lifetime Experiences Scale, RALES). Frequency of daily exposure to racism (RALES Daily Life Experiences Scale). Response to racism (Racism-Related Experiences, RRE Scale).
|
|
|
There were no main effects of either of the three racism measures on preterm birth. A score above the median on the RALES, however, was associated with an increased risk of preterm birth in women with high (vs. low) levels of stress (HR = 1.32, 95% CI, 0.64–3.57, p = 0.05) and in women with high (vs. low) levels of depressive symptoms (HR = 1.55, 95% CI, 0.90–2.64, p = 0.08). For women with low scores on both stress and depressive symptoms, experienced racism had a slight protective effect (HR = 0.63, 95% CI, 0.36–1.08).
|
Strong |
| Mustillo et al. (2004) [41] |
Birmingham, AL, Chicago, IL., Oakland, CA, Minneapolis, MN, USA |
Pregnant women, Chicago, IL., Oakland, CA., Minneapolis, MN. (N = 352). |
Prospective cohort study. |
|
|
Preterm birth (<37 w), Birth weight.
|
Among Black women, 50% (n = 16) of those with preterm deliveries and 61% (n = 8) of those with low-birth-weight infants had experienced racial discrimination in at least 3 situations. The corresponding rates for White women were 5% and 0%, respectively. The odds of giving birth preterm or to low-birth-weight infants were 205% (OR = 3.05, 95% CI, 1.29–7.24) and 398% (OR = 4.98, 95% CI, 1.43–17.39) greater, respectively, for women who had experienced racial discrimination >2 life domains compared to women who had not experienced discrimination. Depressive symptoms did not mediate these relationships.
|
Strong |
| Rankin et al. (2011) [49] |
Chiacgo, IL, USA |
Black mothers (N = 277). |
Case-control, repeated measures study. |
Frequency of past-year and lifetime experienced public-setting racism (Perceived Racism Scale), Coping with experienced racism.
|
Age, Education, Marital status, Parity, Prenatal care, Income, Smoking, Alcohol use.
|
|
Lifetime and past-year experienced racial discrimination was associated with increased odds of preterm birth, (OR = 1.5, 95% CI, 0.9–2.8; OR = 2.5, 95% CI, 1.2–5.2, respectively). In terms of passive coping behavior, there was no moderating effect on the association between experienced racial discrimination and preterm birth. In terms of active coping behavior, women who reported ‘working harder to prove perpetrator wrong’ or ‘getting violent’ had lower risk of preterm birth (p < 0.05).
|
Strong |
| Rosenberg et al. (2002) [53] |
12 states, USA |
Non-Hispanic Black mothers (N = 4966). Mothers of preterm children (n = 422) and normal-term children (n = 4544). |
Case-control study. |
|
Age, Parity, Previous preterm birth, Mother born preterm, Education, Smoking, Alcohol use, Second job, Asthma, Vaginal douching, High blood pressure, Diabetes during pregnancy, BMI, Geographic area of residence, Marital status.
|
|
Women who reported unfair treatment at work (n = 251) were more likely to give birth preterm (OR = 1.3, 95% CI, 1.1–1.6). Women who reported that people acted afraid of them at least once a week (n = 50) were more likely to give birth preterm (OR = 1.4, 95% CI, 1.0–1.9). Preterm birth was also more likely for women who had less than 12 years education (n = 46) and who had experienced discrimination in housing (OR = 2.4, 95% CI, 1.2–4.6), in receiving service at least once a week (OR = 3.4, 95% CI, 1.5–7.7), and in terms of being feared by others at least once a week (OR = 2.0, 95% CI, 1.0–4.1).
|
Strong |
| Scholaske et al. (2019) [54] |
Germany |
Non-immigrant German women (n = 2308) and Turkish immigrants (n = 217). |
Longitudinal nation-wide panel study |
|
Infant sex, Maternal age, Parity, Education, Generation status (1st vs. 2nd) (for Turkish-German cohort only). BMI, Smoking during pregnancy, Pregnancy complications (e.g., hypertension, pre-eclampsia, etc.).
|
Preterm birth (<37 w), Birth weight.
|
Preterm birth was more likely for Turkish immigrants compared to non-immigrant women (b = 1.29, SE = 0.38, p < 0.001, OR = 3.61, 95% CI, 1.76–7.79). Turkish immigrants who had experienced discrimination before birth had higher risk of preterm birth (35.42%) than those who had not experienced discrimination (11.84%) (χ2(1, 109) = 8.18, p < 0.01, OR = 4.19), with lower gestational age (t(87.68 = 3.29, p < 0.01, d = 0.65) and birth weight (t(76.60 = 2.25, p < 0.05, d = 0.45). Overall, women who had experienced discrimination vs. those who had not, had a five-fold increase in risk of preterm birth, OR = 5.76, 95% CI, 1.95–19.38).
|
Moderate |
| Shiono et al. (1997) [55] |
Chicago, IL, and New York, NY, USA |
Pregnant Black, Chinese, Dominican, Puerto Rican, Mexican, and White women (N = 1150). |
Cross-sectional study. |
|
|
|
|
Weak |
| Slaughter-Acey et al. (2016) [50] |
Detroit, MI, USA |
Black women (N = 1410). |
Retrospective cohort study. |
|
|
|
Women in the second quartile of experienced discrimination exhibited a greater probability of preterm birth than women with higher (3rd & 4th quartile) or lower scores (1st quartile). E.g., women in the second discrimination quartile had 67% higher odds of preterm birth than women in the first discrimination quartile (OR = 1.67, 95% CI, 1.16–2.40). Women in the 3rd and 4th discrimination quartile also had greater odds of preterm birth than women in the 1st quartile, but these results were statistically non-significant. Experienced racism interacted with depression to impact preterm birth, but in a non-linear fashion. For women with mild to moderate depressive symptoms, the predictive probability of preterm birth increased from 0.10 for women in the 1st discrimination quartile (low) to 0.20 for women in the 2nd quartile (low-medium) and then decreased again to 0.10 in the 4th quartile (p < 0.05).
|
Strong |
| Slaughter-Acey et al. (2019) [48] |
Baltimore, MD, USA |
Black women (N = 778). |
Hybrid retrospective and prospective cohort study. |
Frequency of past-year and lifetime experienced racial discrimination (Racism and Life Experiences Scale). Frequency of past-year and lifetime group-based experiences of racism (Racism and Life Experiences Scale).
|
Parity, Recruitment status (prenatal, postnatal), Education, Employment during pregnancy, Receipts of Medicaid insurance, Maternal height, Family Resource Scale (time and money).
|
|
Maternal age and experienced racial discrimination interacted to impact on birth weight. Women over 25 (n = 257) had greater odds of giving birth to small-for-gestational-age babies for each one-unit increase in experienced overall and group-based racism (OR = 1.45, 95% CI, 1.02–2.08; OR = 2.84, 95% CI, 1.10–7.32, respectively). No such relationship was evident for younger women.
|
Strong |
| Thayer et al. (2019) [7] |
Aotearoa, New Zealand |
Pregnant Māori (n = 510), Pacific (n = 452), Asian (n = 691) women (N = 1653). |
Longitudinal cohort study. |
|
Maternal age, Maternal BMI, Household income, Education, Relationship status, Smoking, Offspring sex
|
|
Māori women who reported lifetime experiences of discrimination at work or in acquiring housing had lower-birth-weight children than those who had not experienced such discrimination (β = −243 g, 95% CI, −425 g, −60.2 g; (β = −146 g, 95% CI, −286 g, −6 g, respectively). Compared to Asian women who reported no discrimination in housing, Asian women who had experienced lifetime discrimination in housing were more likely to have higher birth-weight-children (β = 188 g, 95% CI, 7 g, 369 g). Shorter gestation length was evident for Māori women who reported lifetime experiences of ethnically motivated physical attacks (β = −1.06 week, 95% CI, −1.8 week, −0.3 week) or unfair treatment in the workplace (β = −0.95 week, 95% CI, −1.6 week, −0.3 week), the criminal justice system (β = −0.55 week, 95% CI, −1.1 week, 0.02 week), or in banking (β = −0.73 week, 95% CI, −1.4 week, −0.02 week).
|
Strong |
| Thayer and Kuzawa (2015) [46] |
Auckland, New Zealand |
Pregnant women (N = 64). |
Prospective cohort study. |
|
Maternal age, Maternal height, Maternal weight SES Ethnicity, Education, Smoking, Exercise, Depression, Material deprivation PTSD.
|
|
Women who had been treated with less respect because of their ethnicity (n = 10) were more likely to self-report poor health than women who had not experienced discrimination (OR = 1.58, SE = 0.72, p = 0.03, R2 = 0.06). Women who had experienced ethnic discrimination exhibited (n = 22) higher levels of evening cortisol levels (1.25 ng/mL) than women who had experienced low levels of discrimination (0.9 ng/mL, p < 0.01) or none at all (0.8 ng/mL, p < 0.001). Infants (n = 19) of women who had experienced discrimination vs. those who had not, had greater cortisol response to vaccination (β = 6.43, SE = 2.60, t = 2.47, p < 0.05).
|
Moderate |
