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Observational Study
. 2018 Feb;131(2):328-335.
doi: 10.1097/AOG.0000000000002441.

Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress

William A Grobman  1 , Corette B Parker, Marian Willinger, Deborah A Wing, Robert M Silver, Ronald J Wapner, Hyagriv N Simhan, Samuel Parry, Brian M Mercer, David M Haas, Alan M Peaceman, Shannon Hunter, Pathik Wadhwa, Michal A Elovitz, Tatiana Foroud, George Saade, Uma M Reddy; Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*
Affiliations
Observational Study

Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress

William A Grobman et al. Obstet Gynecol. 2018 Feb.

Abstract

Objective: To assess the relationships between self-reported psychosocial stress and preterm birth, hypertensive disease of pregnancy, and small-for-gestational-age (SGA) birth and to assess the extent to which these relationships account for racial and ethnic disparities in these adverse outcomes.

Methods: Self-reported measures of psychosocial stress (perceived stress, depression, racism, anxiety, resilience, and social support) were collected during pregnancy among a racially and ethnically diverse cohort of women enrolled in a prospective observational study of nulliparous women with singleton pregnancies, from eight clinical sites across the United States, between October 2010 and May 2014. The associations of preterm birth, hypertensive disease of pregnancy, and SGA birth with the self-reported measures of psychosocial stress as well as with race and ethnicity were evaluated.

Results: The study included 9,470 women (60.4% non-Hispanic white, 13.8% non-Hispanic black, 16.7% Hispanic, 4.0% Asian, and 5.0% other). Non-Hispanic black women were significantly more likely to experience any preterm birth, hypertensive disease of pregnancy, and SGA birth than were non-Hispanic white women (12.2% vs 8.0%, 16.7% vs 13.4%, and 17.2% vs 8.6%, respectively; P<.05 for all). After adjusting for potentially confounding factors, including the six different psychosocial factors singly and in combination, non-Hispanic black women continued to be at greater risk of any preterm birth and SGA birth compared with non-Hispanic white women.

Conclusion: Among a large and geographically diverse cohort of nulliparous women with singleton gestations, non-Hispanic black women are most likely to experience preterm birth, hypertensive disease of pregnancy, and SGA birth. These disparities were not materially altered for preterm birth or SGA birth by adjustment for demographic differences and did not appear to be explained by differences in self-reported psychosocial factors.

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Figures

Figure 1
Figure 1
Flow diagram for enrollment and inclusion in analysis
Figure 2
Figure 2
Patterns of response to psychosocial assessments using latent profile analysis
See this image and copyright information in PMC

References

    1. Spong CY. Prediction and prevention of recurrent spontaneous preterm birth. Obstet Gynecol. 2007;110:405–15. - PubMed
    1. MacDorman MF, Declercq E, Zhang J. Obstetrical Intervention and the Singleton Preterm Birth Rate in the United States From 1991–2006. Am J Public Health. 2010;100:2241–7. - PMC - PubMed
    1. McKinnon B, Yang S, Kramer MS, et al. Comparison of black–white disparities in preterm birth between Canada and the United States. CMAJ. 2016;188:E19–26. - PMC - PubMed
    1. Warnecke RB, Oh A, Breen N, et al. Approaching health disparities from a population perspective: The National Institutes of Health Centers for Population Health and Health Disparities. Am J Public Health. 2008;98:1608–15. - PMC - PubMed
    1. Vos AA, Posthumus AG, Bonsel GJ, Steegers EA, Denktaş S. Deprived neighborhoods and adverse perinatal outcome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2014;93:727–40. - PubMed

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