Perceived racism or racial discrimination and the risk of adverse obstetric outcomes
a systematic review
Keywords:
Pregnancy, Racism, Systematic review [publication type]Abstract
BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov data- bases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42020194382
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References
Bailey ZD, Krieger N, Agénor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453-63. PMID: 28402827; https://doi.org/10.1016/S0140-6736(17)30569-X
Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Semin Perinatol. 2017;41(5):308-17. PMID: 28625554; https://doi.org/10.1053/j.semperi.2017.04.008
Wang E, Glazer KB, Howell EA, Janevic TM. Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review. Obstet Gynecol. 2020;135(4):896-915. PMID: 32168209; https://doi.org/10.1097/AOG.0000000000003762
Dominguez TP. Race, racism, and racial disparities in adverse birth outcomes. Clin Obstet Gynecol. 2008;51(2):360-70. PMID: 18463466; https://doi.org/10.1097/GRF.0b013e31816f28de
Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000;21(4):75-90. PMID: 11481746.
Phelan JC, Link BG. Is Racism a Fundamental Cause of Inequalities in Health? Annual Review of Sociology. 2015;41(1):311-30. Available from: https://www.annualreviews.org/doi/abs/10.1146/annurev-soc-073014-112305 Accessed in 2022 (Apr 12).
Ramaswamy M, Kelly PJ. Institutional Racism as a Critical Social Determinant of Health. Public Health Nurs. 2015;32(4):285-6. PMID: 26199054; https://doi.org/10.1111/phn.12212
Ford CL, Airhihenbuwa CO. Critical Race Theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010;100 Suppl 1(Suppl 1):S30-5. PMID: 20147679; https://doi.org/10.2105/AJPH.2009.171058
Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiologia e Serviços de Saúde. 2015;24:335-42. https://doi.org/10.5123/S1679-49742015000200017
Panic N, Leoncini E, De Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PloS One. 2013;8(12):e83138. PMID: 24386151; https://doi.org/10.1371/journal.pone.0083138
Booth A, Moher D, Ghersi D, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2. PMID: 22587842; https://doi.org/10.1186/2046-4053-1-2
Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576-96. PMID: 16005789; https://doi.org/10.1016/j.socscimed.2005.03.006
Bond M, Kalaje A, Markkanen P, et al. Expanding our understanding of the psychosocial environment: A compendium of measures of discrimination, harassment and work-family issues. NIOSH; 2007. https://doi.org/10.26616/nioshpub2008104
Harrell S P Racism and Life Experiences Scales: Racial Hassles (RaLES) [Database record]. APA PsycTests. 1997. https://doi.org/10.1037/t09928-000
Massey DS, Denton NA. The dimensions of residential segregation. Social forces. 1988;67(2):281-315. https://doi.org/10.2307/2579183
Williams DR, Gonzalez HM, Williams S, et al. Perceived discrimination, race and health in South Africa. Soc Sci Med. 2008;67(3):441-52. PMID: 18486292; https://doi.org/10.1016/j.socscimed.2008.03.021
Krieger N, Waterman PD, Spasojevic J, et al. Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes. Am J Public Health. 2016;106(2):256-63. PMID: 26691119; https://doi.org/10.2105/AJPH.2015.302955
Attanasio L, Kozhimannil KB. Health Care Engagement and Follow-up After Perceived Discrimination in Maternity Care. Med Care. 2017;55(9):830-3. PMID: 28692572; https://doi.org/10.1097/MLR.0000000000000773
Lewis JA, Neville HA. Construction and initial validation of the Gendered Racial Microaggressions Scale for Black women. J Couns Psychol. 2015;62(2):289-302. PMID: 25867696; https://doi.org/10.1037/cou0000062
Paradies YC, Cunningham J. Development and validation of the Measure of Indigenous Racism Experiences (MIRE). Int J Equity Health. 2008;7:9. PMID: 18426602; https://doi.org/10.1186/1475-9276-7-9
Harrell SP. A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. A J Orthopsychiatry. 2000;70(1):42-57. PMID: 10702849; https://doi.org/10.1037/h0087722
Dole N, Savitz DA, Siega-Riz AM, et al. Psychosocial factors and preterm birth among African American and White women in central North Carolina. Am J Public Health. 2004;94(8):1358-65. PMID: 15284044; https://doi.org/10.2105/ajph.94.8.1358
Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273-81. PMID: 2367873; https://doi.org/10.1016/0277-9536(90)90307-e
Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996;86(10):1370-8. PMID: 8876504; https://doi.org/10.2105/ajph.86.10.1370
Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. PMID: 27733354; https://doi.org/10.1136/bmj.i4919
Nguyen KH, Subramanian SV, Sorensen G, Tsang K, Wright RJ. Influence of experiences of racial discrimination and ethnic identity on prenatal smoking among urban black and Hispanic women. J Epidemiol Community Health. 2012;66(4):315-21. PMID: 20974840; https://doi.org/10.1136/jech.2009.107516
Slaughter-Acey JC, Sneed D, Parker L, et al. Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care. Am J Prev Med. 2019;57(3):321-9. PMID: 31353164; https://doi.org/10.1016/j.amepre.2019.04.014
Slaughter-Acey JC, Caldwell CH, Misra DP. The influence of personal and group racism on entry into prenatal care among African American women. Womens Health Issues. 2013;23(6):e381-7. PMID: 24041828; https://doi.org/10.1016/j.whi.2013.08.001
Bécares L, Atatoa-Carr P. The association between maternal and partner experienced racial discrimination and prenatal perceived stress, prenatal and postnatal depression: findings from the growing up in New Zealand cohort study. Int J Equity Health. 2016;15(1):155. PMID: 27658457; https://doi.org/10.1186/s12939-016-0443-4
Stancil TR, Hertz-Picciotto I, Schramm M, Watt-Morse M. Stress and pregnancy among African-American women. Paediatr Perinat Epidemiol. 2000;14(2):127-35. PMID: 10791655; https://doi.org/10.1046/j.1365-3016.2000.00257.x
Grobman WA, Parker C, Wadhwa PD, et al. Racial/Ethnic Disparities in Measures of Self-reported Psychosocial States and Traits during Pregnancy. Am J Perinatol. 2016;33(14):1426-32. PMID: 27500932; https://doi.org/10.1055/s-0036-1586510
Grobman WA, Parker CB, Willinger M, et al. Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress. Obstet Gynecol. 2018;131(2):328-35. PMID: 29324613; https://doi.org/10.1097/AOG.0000000000002441
Mendez DD, Sanders SA, Lai YH, et al. Ecological momentary assessment of stress, racism and other forms of discrimination during pregnancy using smartphone technology. Paediatr Perinat Epidemiol. 2020;34(5):522-31. PMID: 31930744; https://doi.org/10.1111/ppe.12619
Chambers BD, Arabia SE, Arega HA, et al. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health. 2020;36(2):213-9. PMID: 31919987; https://doi.org/10.1002/smi.2922
Christian LM, Iams JD, Porter K, Glaser R. Epstein-Barr virus reactivation during pregnancy and postpartum: effects of race and racial discrimination. Brain Behav Immun. 2012;26(8):1280-7. PMID: 22940537; https://doi.org/10.1016/j.bbi.2012.08.006
Hilmert CJ, Dominguez TP, Schetter CD, et al. Lifetime racism and blood pressure changes during pregnancy: implications for fetal growth. Health Psychol. 2014;33(1):43-51. PMID: 23379383; https://doi.org/10.1037/a0031160
Peters RM, Benkert R, Templin TN, Cassidy-Bushrow AE. Measuring African American women's trust in provider during pregnancy. Res Nurs Health. 2014;37(2):144-54. PMID: 24395526; https://doi.org/10.1002/nur.21581
Yang TC, Shoff C, Noah AJ, Black N, Sparks CS. Racial segregation and maternal smoking during pregnancy: a multilevel analysis using the racial segregation interaction index. Soc Sci Med. 2014;107:26-36. PMID: 24602968; https://doi.org/10.1016/j.socscimed.2014.01.030
Attanasio L, Kozhimannil KB. Patient-reported Communication Quality and Perceived Discrimination in Maternity Care. Med Care. 2015;53(10):863-71. PMID: 26340663; https://doi.org/10.1097/MLR.0000000000000411
Borders AE, Wolfe K, Qadir S, et al. Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy. J Perinatol. 2015;35(8):580-4. PMID: 25789817; https://doi.org/10.1038/jp.2015.18
Francis B, Klebanoff M, Oza-Frank R. Racial discrimination and perinatal sleep quality. Sleep Health. 2017;3(4):300-5. PMID: 28709519; https://doi.org/10.1016/j.sleh.2017.05.012
Rosenberg L, Palmer JR, Wise LA, Horton NJ, Corwin MJ. Perceptions of racial discrimination and the risk of preterm birth. Epidemiology. 2002;13(6):646-52. PMID: 12410005; https://doi.org/10.1097/00001648-200211000-00008
Mustillo S, Krieger N, Gunderson EP, Sidney S, McCreath H, Kiefe CI. Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study. Am J Public Health. 2004;94(12):2125-31. PMID: 15569964; https://doi.org/10.2105/ajph.94.12.2125
Misra D, Strobino D, Trabert B. Effects of social and psychosocial factors on risk of preterm birth in black women. Paediatr Perinat Epidemiol. 2010;24(6):546-54. PMID: 20955232; https://doi.org/10.1111/j.1365-3016.2010.01148.x
Braveman P, Heck K, Egerter S, et al. Worry about racial discrimination: A missing piece of the puzzle of Black-White disparities in preterm birth? PLoS One. 2017;12(10):e0186151. PMID: 29020025; https://doi.org/10.1371/journal.pone.0186151
Bower KM, Geller RJ, Perrin NA, Alhusen J. Experiences of Racism and Preterm Birth: Findings from a Pregnancy Risk Assessment Monitoring System, 2004 through 2012. Womens Health Issues. 2018;28(6):495-501. PMID: 30049447; https://doi.org/10.1016/j.whi.2018.06.002
Fryer KE, Vines AI, Stuebe AM. A Multisite Examination of Everyday Discrimination and the Prevalence of Spontaneous Preterm Birth in African American and Latina Women in the United States. Am J Perinatol. 2020;37(13):1340-50. PMID: 31365929; https://doi.org/10.1055/s-0039-1693696
Wheeler S, Maxson P, Truong T, Swamy G. Psychosocial Stress and Preterm Birth: The Impact of Parity and Race. Matern Child Health J. 2018;22(10):1430-5. PMID: 29600473; https://doi.org/10.1007/s10995-018-2523-0
Slaughter-Acey JC, Sealy-Jefferson S, Helmkamp L, et al. Racism in the form of micro aggressions and the risk of preterm birth among black women. Ann Epidemiol. 2016;26(1):7-13.e1. PMID: 26549132; https://doi.org/10.1016/j.annepidem.2015.10.005
Brown SJ, Gartland D, Weetra D, et al. Health care experiences and birth outcomes: Results of an Aboriginal birth cohort. Women Birth. 2019;32(5):404-11. PMID: 31202584; https://doi.org/10.1016/j.wombi.2019.05.015
Lespinasse AA, David RJ, Collins JW, Handler AS, Wall SN. Maternal support in the delivery room and birthweight among African-American women. J Natl Med Assoc. 2004;96(2):187-95. PMID: 14977277.
Collins JW, Jr., David RJ, Handler A, Wall S, Andes S. Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. Am J Public Health. 2004;94(12):2132-8. PMID: 15569965; https://doi.org/10.2105/ajph.94.12.2132
Dominguez TP, Dunkel-Schetter C, Glynn LM, Hobel C, Sandman CA. Racial differences in birth outcomes: the role of general, pregnancy, and racism stress. Health Psychol. 2008;27(2):194-203. PMID: 18377138; https://doi.org/10.1037/0278-6133.27.2.194
Mund M, Louwen F, Klingelhoefer D, Gerber A. Smoking and pregnancy--a review on the first major environmental risk factor of the unborn. Int J Environ Res Public Health. 2013;10(12):6485-99. PMID: 24351784; https://doi.org/10.3390/ijerph10126485
Hobel CJ, Goldstein A, Barrett ES. Psychosocial stress and pregnancy outcome. Clin Obstet Gynecol. 2008;51(2):333-48. PMID: 18463464; https://doi.org/10.1097/GRF.0b013e31816f2709
Bramham K, Parnell B, Nelson-Piercy C, et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301. PMID: 24735917; https://doi.org/10.1136/bmj.g2301
McLemore MR, Altman MR, Cooper N, et al. Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth. Soc Sci Med. 2018;201:127-35. PMID: 29494846; https://doi.org/10.1016/j.socscimed.2018.02.013
Hogue CJR, Bremner JD. Stress model for research into preterm delivery among black women. Am J Obstet Gynecol. 2005;192(5 Suppl):S47-55. PMID: 15891712; https://doi.org/10.1016/j.ajog.2005.01.073
Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth. J Am Board Fam Med. 2016;29(3):308-17. PMID: 27170788; https://doi.org/10.3122/jabfm.2016.03.150300
Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011. Psychosoc Med. 2012;9: Doc11. PMID: 23133505; https://doi.org/10.3205/psm000089
