Examining the Influence of Racial Discrimination on Adverse Birth Outcomes: An Analysis of the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS), 2016-2018.

OBJECTIVES

In Virginia, Black women experience higher rates of adverse birth and labor outcomes that may not be explained solely by risky behaviors or social standing. Previous studies have found an association between racial discrimination and adverse birth outcomes; however, their findings may be underpowered due to small sample sizes. The purpose of this study was to examine the relationship between racial discrimination and poor birth outcomes.

METHODS

VA PRAMS (2016-2018) was used for this secondary data analysis of mothers age 15-44. The exposure was measured using two VA PRAMS questions on racial discrimination and information on the outcomes were extracted from birth certificate data. Simple logistic regression was used obtain an association between experiencing racial discrimination and adverse birth outcomes (i.e. preterm birth, low birth weight, and small for gestational age) and to identify risk factors for experiencing racial discrimination. Multivariate logistic regressions were performed after controlling for other covariates.

RESULTS

Virginia women (N = 2634) who experienced racial discrimination had statistically significant increased odds of having a low birth weight infant (OR 2.27; 95% CI 1.18, 4.38); however, when stratified by race, only non-Hispanic Black (n = 540) women had statistically significant increased odds of preterm birth and low birth weight (PTB OR 7.18; 95% CI 2.28, 22.65; LBW OR 3.56; 95% CI 1.28, 9.91).

CONCLUSIONS

Non-Hispanic Black women in Virginia who experience racial discrimination are more likely to have low birth weight and preterm births. Efforts to effectively reduce adverse birth outcomes and eliminate racial inequities must consider upstream, holistic approaches beyond the biomedical model.