Abstract
Objectives
To evaluate the effect of race and ethnicity on differences in maternal and perinatal outcomes among U.S.-born and foreign-born women, as well as racial and ethnic disparities in outcomes within these groups.
Methods
This retrospective study analyzed singleton pregnancies (n = 11,518) among women delivering at Boston Medical Center from January 2010–March 2015. Outcomes of interest included preterm birth, early preterm birth, cesarean delivery, hypertensive disorders, diabetes, low birth weight at term (LBW, < 2500 g), NICU admission and intrauterine fetal demise (IUFD). Prevalence ratios and 95% confidence intervals comparing outcomes between U.S.- and foreign-born women were calculated and stratified by race. Obstetric outcomes among Black and Hispanic women were compared to those of white women within both U.S.- and foreign-born groups.
Results
Preterm birth, hypertensive disorders, LBW and NICU admission were more likely to occur among U.S.-born women and their neonates compared to foreign-born women. Controlling for sociodemographic characteristics did not significantly impact these disparities. Among foreign-born women, Black women had a higher prevalence of many maternal and neonatal complications, while Hispanic women had a lower prevalence of some complications compared to white women. Black woman and infants consistently exhibit worse outcomes regardless of their nativity, while Hispanic women foreign-born women experience less disparate outcomes.
Conclusions for Practice
Overall, women born in the United States are at higher risk of several adverse perinatal outcomes compared to foreign-born women. Racial and ethnic disparities in birth outcomes exist in both groups. However, the complex interplay between biopsychosocial influences that mediate these inequities appear to have different effects among U.S- and foreign- born women. A better understanding of these factors can be used to combat disparities and improve outcomes for all women.
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TMA, SEP, and LFP contributed to the study conception, study design, and manuscript preparation. Data collection was performed by TMA and LFP. Data analysis was performed by OV, NN, and SEP. All of the authors contributed to the manuscript drafting. All authors read and approved the final manuscript for submission to the Maternal and Child Health Journal.
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This study was approved by the Boston Medical Center and Boston University Medical Campus Institutional Review Board (IRB #H-34031).
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Adegoke, T.M., Pinder, L.F., Ndiwane, N. et al. Inequities in Adverse Maternal and Perinatal Outcomes: The Effect of Maternal Race and Nativity. Matern Child Health J 26, 823–833 (2022). https://doi.org/10.1007/s10995-021-03225-0
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DOI: https://doi.org/10.1007/s10995-021-03225-0