Skip to main content

Advertisement

SpringerLink
Log in

Systematic Review of Chronic Discrimination and Changes in Biology During Pregnancy Among African American Women

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Profound racial health disparities in maternal and infant health exist in the USA. Discrimination based on race may contribute to these disparities, but the biological pathways through which racial discrimination acts on health are not fully known. Even less is known about these pathways during development. Examining how racial discrimination becomes biology is paramount because it may shed light on how and when such social forces result in lasting biological consequences for health and wellbeing. To begin exploring this issue, we performed a systematic review of the relationships between experiences of chronic racial discrimination and relevant biomarkers measured during pregnancy among African American women. The literature search included studies published prior to August 2018 in the MEDLINE, Embase, and PsycINFO databases, and 11 studies met our inclusion criteria. We evaluated the articles based on the biological system that the authors investigated, which included the immune, neuroendocrine, and cardiovascular systems. We found that the current literature provides preliminary evidence that experiences of chronic racial discrimination are associated with changes in maternal biology during pregnancy. However, the literature was limited in both quantity and quality. We found only 11 studies that addressed this subject, four of which only provided indirect evidence, and many studies had small sample sizes. Future work in this area should develop more informative methods that consider the interaction between interpersonal and structural racial discrimination, individual variation, and sociocultural factors. We conclude researchers should continue to work in this area and focus on developing more effective study designs and larger sample sizes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Riddell CA, Harper S, Kaufman JS. Trends in differences in US mortality rates between black and white infants. JAMA Pediatr. 2017;171(9):911–3. https://doi.org/10.1001/jamapediatrics.2017.1365.

    Article  PubMed  PubMed Central  Google Scholar 

  2. March of Dimes. 2018. Premature report card United States 2018. Retrieved April 11, 2019, from https://www.marchofdimes.org/materials/PrematureBirthReportCard-United States-2018.pdf.

  3. Singh GK, Siahpush M, Liu L, Allender M. Racial/ethnic, nativity, and sociodemographic disparities in maternal hypertension in the United States, 2014–2015. Int J Hypertens. 2018;2018:1–14. https://doi.org/10.1155/2018/7897189.

    Article  CAS  Google Scholar 

  4. Centers for Disease Control and Prevention. Vital Statistics Online Data Portal. https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm . Accessed 15 May 2019

  5. Gravlee CC. How race becomes biology: embodiment of social inequality. Am J Phys Anthropol. 2009;139(1):47–57. https://doi.org/10.1002/ajpa.20983.

    Article  PubMed  Google Scholar 

  6. David R, Collins J. Disparities in infant mortality: what’s genetics got to do with it? Am J Public Health. 2007;97(7):1191–7. https://doi.org/10.2105/AJPH.2005.068387.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Acevedo-Garcia D, Soobader M-J, Berkman LF. The differential effect of foreign-born status on low birth weight by race/ethnicity and education. Pediatrics. 2005;115(1):e20–30. https://doi.org/10.1542/peds.2004-1306.

    Article  PubMed  Google Scholar 

  8. Cabral H, Fried LE, Levenson S, Amaro H, Zuckerman B. Foreign-born and US-born black women: differences in health behaviors and birth outcomes. Am J Public Health. 1990;80(1):70–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. David RJ, Collins JW Jr. Differing birth weight among infants of US-born blacks, African-born blacks, and US-born whites. New Engl J Med. 1997;337(17):1209–14.

    Article  CAS  PubMed  Google Scholar 

  10. Forna F, Jamieson DJ, Sanders D, Lindsay MK. Pregnancy outcomes in foreign-born and US-born women. Int J Gynecol Obstet. 2003;83(3):257–65. https://doi.org/10.1016/S0020-7292(03)00307-2.

    Article  CAS  Google Scholar 

  11. Kleinman JC, Fingerhut LA, Prager K. Differences in infant mortality by race, nativity status, and other maternal characteristics. Am J Dis Child. 1991;145(2):194–9.

    CAS  PubMed  Google Scholar 

  12. Singh GK, Yu SM. Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups. Am J Public Health. 1996;86(6):837–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Collins JW, Wu S-Y, David RJ. Differing intergenerational birth weights among the descendants of US-born and foreign-born whites and African Americans in Illinois. Am J Epidemiol. 2002;155(3):210–6. https://doi.org/10.1093/aje/155.3.210.

    Article  PubMed  Google Scholar 

  14. Collins JW, David RJ. The differential effect of traditional risk factors on infant birthweight among blacks and whites in Chicago. Am J Public Health. 1990;80(6):679–81.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54. https://doi.org/10.1037/a0016059.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47. https://doi.org/10.1007/s10865-008-9185-0.

    Article  PubMed  Google Scholar 

  17. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8. https://doi.org/10.2105/AJPH.93.2.200.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Collins JW, 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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. https://doi.org/10.1037/0278-6133.27.2.194.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Giscombé CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131(5):662–83. https://doi.org/10.1037/0033-2909.131.5.662.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press; 2003.

    Google Scholar 

  22. Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341(8850):938–41.

    Article  CAS  PubMed  Google Scholar 

  23. Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986;1(8489):1077–81.

    Article  CAS  PubMed  Google Scholar 

  24. Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989;2(8663):577–80.

    Article  CAS  PubMed  Google Scholar 

  25. Christian LM. Physiological reactivity to psychological stress in human pregnancy: current knowledge and future directions. Prog Neurobiol. 2012;99(2):106–16. https://doi.org/10.1016/j.pneurobio.2012.07.003.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med. 2013;6(2):52–7. https://doi.org/10.1177/1753495x12473751.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Graignic-Philippe R, Dayan J, Chokron S, Jacquet A-Y, Tordjman S. Effects of prenatal stress on fetal and child development: a critical literature review. Neurosci Biobehav Rev. 2014;43:137–62. https://doi.org/10.1016/j.neubiorev.2014.03.022.

    Article  CAS  PubMed  Google Scholar 

  28. Davis EF, Lazdam M, Lewandowski AJ, Worton SA, Kelly B, Kenworthy Y, et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics. 2012;129(6):e1552–61. https://doi.org/10.1542/peds.2011-3093.

    Article  PubMed  Google Scholar 

  29. Yeung EH, Robledo C, Boghossian N, Zhang C, Mendola P. Developmental origins of cardiovascular disease. Curr Epidemiol Rep. 2014;1(1):9–16. https://doi.org/10.1007/s40471-014-0006-4.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Buss C, Davis EP, Shahbaba B, Pruessner JC, Head K, Sandman CA. Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci U S A. 2012;109(20):E1312–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Davis EP, Glynn LM, Schetter CD, Hobel C, Chicz-demet A, Sandman CA. Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry. 2007;46(6):737–46. https://doi.org/10.1097/chi.0b013e318047b775.

    Article  PubMed  Google Scholar 

  32. Davis EP, Glynn LM, Waffarn F, Sandman CA. Prenatal maternal stress programs infant stress regulation. J Child Psychol Psychiatry. 2011;52(2):119–29. https://doi.org/10.1111/j.1469-7610.2010.02314.x.

    Article  PubMed  Google Scholar 

  33. French NP, Hagan R, Evans SF, Mullan A, Newnham JP. Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior. Am J Obstet Gynecol. 2004;190(3):588–95. https://doi.org/10.1016/j.ajog.2003.12.016.

    Article  CAS  PubMed  Google Scholar 

  34. Holmes MC, Abrahamsen CT, French KL, Paterson JM, Mullins JJ, Seckl JR. The mother or the fetus? 11beta-hydroxysteroid dehydrogenase type 2 null mice provide evidence for direct fetal programming of behavior by endogenous glucocorticoids. J Neurosci. 2006;26(14):3840–4. https://doi.org/10.1523/JNEUROSCI.4464-05.2006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Estes ML, McAllister AK. Maternal immune activation: implications for neuropsychiatric disorders. Science. 2016;353(6301):772–7. https://doi.org/10.1126/science.aag3194.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Rudolph MD, Graham AM, Feczko E, Miranda-Dominguez O, Rasmussen JM, Nardos R, et al. Maternal IL-6 during pregnancy can be estimated from newborn brain connectivity and predicts future working memory in offspring. Nat Neurosci. 2018;21(5):765–72. https://doi.org/10.1038/s41593-018-0128-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Vohr BR, Davis EP, Wanke CA, Krebs NF. Neurodevelopment: the impact of nutrition and inflammation during preconception and pregnancy in low-resource settings. Pediatrics. 2017;139(Supplement 1):S38–49. https://doi.org/10.1542/peds.2016-2828F.

    Article  PubMed  Google Scholar 

  38. Kuzawa CW, Sweet E. Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health. Am J Hum Biol. 2009;21(1):2–15. https://doi.org/10.1002/ajhb.20822.

    Article  PubMed  Google Scholar 

  39. Monk C, Spicer J, Champagne FA. Linking prenatal maternal adversity to developmental outcomes in infants: the role of epigenetic pathways. Dev Psychopathol. 2012;24(4):1361–76. https://doi.org/10.1017/S0954579412000764.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wadhwa PD, Buss C, Entringer S, Swanson JM. Developmental origins of health and disease: brief history of the approach and current focus on epigenetic mechanisms. Semin Reprod Med. 2009;27(5):358–68. https://doi.org/10.1055/s-0029-1237424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Thayer ZM, Kuzawa CW. Biological memories of past environments: epigenetic pathways to health disparities. Epigenetics. 2011;6(7):798–803. https://doi.org/10.4161/epi.6.7.16222.

    Article  PubMed  Google Scholar 

  43. Mendoza VB, Huang Y, Crusto CA, Sun YV, Taylor JY. Perceived racial discrimination and DNA methylation among African American women in the InterGEN study. Biol Res Nurs. 2018;20(2):145–52. https://doi.org/10.1177/1099800417748759.

    Article  CAS  Google Scholar 

  44. Santos HP, Nephew BC, Bhattacharya A, Tan X, Smith L, Alyamani RAS, et al. Discrimination exposure and DNA methylation of stress-related genes in Latina mothers. Psychoneuroendocrinology. 2018;98:131–8. https://doi.org/10.1016/j.psyneuen.2018.08.014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Christian LM, Iams JD, Porter K, Glaser R Reactivation of latent Epstein–Barr virus in pregnancy: effects of race and implications for preterm birth. PsychoNeuroImmunology Research Society’s 19th Annual Scientific Meeting, San Diego; 2012.

  46. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Grobman WA, Parker CB, Willinger M, Wing DA, Silver RM, Wapner RJ, et al. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol. 2018;131(2):328–35.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hilmert CJ, Dominguez TP, Schetter CD, Srinivas SK, Glynn LM, Hobel CJ, et al. Lifetime racism and blood pressure changes during pregnancy: implications for fetal growth. Health Psychol. 2014;33(1):43–51.

    Article  PubMed  Google Scholar 

  49. Thayer J, Koenig J, Williams D, Kapuku G, Christian, LM Impaired vasodilation in pregnant African Americans: potential antecedents and consequences. Paper presented at the American Psychosmatic Society Annual Meeting, Savannah; 2015.

  50. Borders AEB, Wolfe K, Qadir S, Kim K-Y, Holl J, Grobman W. Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy. J Perinatol. 2015;35(8):580–4. https://doi.org/10.1038/jp.2015.18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Christian LM, Glaser R, Porter K, Iams JD. Stress-induced inflammatory responses in women: effects of race and pregnancy. Psychosom Med. 2013;75(7):658–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Giurgescu C, Engeland CG, Templin TN, Zenk SN, Koenig MD, Garfield L. Racial discrimination predicts greater systemic inflammation in pregnant African American women. Appl Nurs Res. 2016;32:98–103.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Simon CD, Adam EK, Holl JL, Wolfe KA, Grobman WA, Borders AE. Prenatal stress and the cortisol awakening response in African-American and Caucasian women in the third trimester of pregnancy. Matern Child Health J. 2016;20(10):2142–9.

    Article  PubMed  Google Scholar 

  54. Suglia SF, Staudenmayer J, Cohen S, Enlow MB, Rich-Edwards JW, Wright RJ. Cumulative stress and cortisol disruption among Black and Hispanic pregnant women in an urban cohort. Psychol Trauma. 2010;2(4):326–4.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tse AC, Rich-Edwards JW, Koenen K, Wright RJ. Cumulative stress and maternal prenatal corticotropin-releasing hormone in an urban U.S. cohort. Psychoneuroendocrinology. 2012;37(7):970–9.

    Article  CAS  PubMed  Google Scholar 

  56. 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.

    Article  CAS  PubMed  Google Scholar 

  57. Dolezsar CM, McGrath JJ, Herzig AJM, Miller SB. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. 2014;33(1):20–34. https://doi.org/10.1037/a0033718.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Gravlee CC, Dressler WW, Bernard HR. Skin color, social classification, and blood pressure in southeastern Puerto Rico. Am J Public Health. 2005;95(12):2191–7. https://doi.org/10.2105/AJPH.2005.065615.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Carter RT. Racism and psychological and emotional injury: recognizing and assessing race-based traumatic stress. Couns Psychol. 2007;35(1):13–105. https://doi.org/10.1177/0011000006292033.

    Article  Google Scholar 

  60. Del Giudice M, Gangestad SW. Rethinking IL-6 and CRP: why they are more than inflammatory biomarkers, and why it matters. Brain Behav Immun. 2018;70:61–75.

    Article  PubMed  Google Scholar 

  61. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flügge G, Korte SM, et al. Stress revisited: a critical evaluation of the stress concept. Neurosci Biobehav Rev. 2011;35(5):1291–301.

    Article  CAS  PubMed  Google Scholar 

  62. Kim EJ, Pellman B, Kim JJ. Stress effects on the hippocampus: a critical review. Learn Mem. 2015;22(9):411–6.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Schoenfeld T, Gould E. Stress, stress hormones, and adult neurogenesis. Exp Neurol. 2012;233(1):12–21. https://doi.org/10.1016/j.expneurol.2011.01.008.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Kendall Arslanian, Katherine Daiy, Victoria Harries, and Stephanie Levy for their comments on various drafts of this manuscript.

Author information

Authors and Affiliations

  1. Department of Anthropology, Yale University, 10 Sachem St, New Haven, CT, 06511, USA

    Carlye Chaney, Marcela Lopez, Kyle S. Wiley & Claudia Valeggia

  2. Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA

    Caitlin Meyer

Authors
  1. Carlye Chaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcela Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyle S. Wiley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caitlin Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Valeggia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlye Chaney.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaney, C., Lopez, M., Wiley, K.S. et al. Systematic Review of Chronic Discrimination and Changes in Biology During Pregnancy Among African American Women. J. Racial and Ethnic Health Disparities 6, 1208–1217 (2019). https://doi.org/10.1007/s40615-019-00622-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-019-00622-8

Keywords

Search

Navigation