Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress

Abstract

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.

Stressor landscapes, birth weight, and prematurity at the intersection of race and income: Elucidating birth contexts through patterned life events

“…Our study provides rich, contextual description and measurement of racial disparities in perinatal health in the US beyond most previous population-based studies. First, our findings agree with other US-based studies finding wide disparities in birth outcomes by race and SEP (Almeida et al, 2018; Amjad et al, 2019; Blumenshine et al, 2010; Braveman et al, 2015; Culhane & Goldenberg, 2011; Grobman et al, 2018). Second, we uncover maternal LE patterns preceding US births that systematically disadvantage low-income and minority women, through differential clustering of toxic stressors.…”

“…But race still has residual effects on birth outcomes beyond what is explicable by SEP indicators, risky health behaviors ( e.g. , smoking or drinking), and healthcare access (Almeida, Becares, Erbetta, Bettegowda, & Ahluwalia, 2018; Lorch & Enlow, 2016; Lu & Chen, 2004). Furthermore, the improvements in birth outcomes with higher SEP among African Americans are not as pronounced as among whites (Braveman et al, 2015).…”

“…For instance, studies focusing on prenatal stressors can overcontrol for important mediators ( e.g. , unhealthy coping strategies like substance use) or overlook racial and ethnic differences in how SEP and psychosocial stressors affect health outcomes (Almeida et al, 2018; Grobman et al, 2018; Lu & Chen, 2004). Meanwhile, studies looking at broader contexts have found that neighborhoods and local income disparities significantly affect birth risks, but how these translate to personal experiences that get under the skin is still understudied (Culhane & Goldenberg, 2011; Ncube, Enquobahrie, Albert, Herrick, & Burke, 2016; Seabrook et al, 2018; Wallace, Mendola, Chen, Hwang, & Grantz, 2016).…”

“…Existing studies focused specifically on the impact of the unequal distribution of maternal LE's on birth outcome inequalities ( i.e. , differential exposure) have rendered inconsistent results, even within US-based studies using the same survey instrument (Almeida et al, 2018; Lu & Chen, 2004).…”

Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype

“…This finding is corroborated by other studies that have found racial and/or ethnic disparities in adverse labor outcomes and PPH morbidity in particular. 7 Racial disparities in perinatal health in general are multifactorial and may be related to differences in access to or engagement in care, 36 disparate hospital care practices, 37,38 racism and segregation, 39,40 pervasive stress, [41][42][43] or epigenetic effects. [44][45][46] Race and ethnicity are not included as part of published PPH risk scoring tools.…”