Self-reported experiences of interpersonal racial discrimination and maternal and neonatal health: a systematic review and meta-analysis.

INTRODUCTION

Racial discrimination contributes to maternal and neonatal health inequities. We synthesized evidence on associations between self-reported interpersonal racial discrimination and maternal and neonatal outcomes.

METHODS

We searched six major bibliographic databases from inception to September 2024, updated October 2025. We included observational epidemiological studies with comparison groups among pregnant or previously pregnant women. Outcomes included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), mode of delivery, postpartum depression (PPD), fetal growth and gestational outcomes, infant mortality, and neonatal intensive care unit (NICU) admission. Two independent reviewers screened studies and assessed risk of bias using the Newcastle-Ottawa Scales and the Appraisal Tool for Cross-Sectional Studies. Random-effects meta-analyses generated pooled adjusted odds ratios (aOR) with 95% confidence intervals (CI).

RESULTS

From 20,361 records, 61 publications of 63 studies including 1,473,417 participants were included. No associations were reported for HDP or GDM. Evidence was strongest for PPD, with higher odds in cohort (pooled aOR 1·37, 95% CI 1·16-1·63) and cross-sectional studies (pooled aOR 1·82, 95% CI 1·35-2·47). Cohort studies showed no association with PTB, whereas cross-sectional studies indicated increased odds (pooled aOR 1·19, 95% CI 1·03-1·38). Higher odds were observed for low birth weight (LBW) (pooled aOR 2·21, 95% CI 1·46-3·35), and very LBW (pooled aOR 2·70, 95% CI 1·40-5·20). Evidence for other outcomes was inconsistent. No studies examined infant mortality or NICU admission. Most included studies were at moderate risk of bias.

CONCLUSIONS

Interpersonal racial discrimination is associated with PPD and LBW. Racial discrimination should be considered a modifiable determinant of maternal and neonatal health and integrated into perinatal research and care to reduce inequities.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022312529, identifier CRD42022312529.