Table 2

Results of included studies

StudyExposure and outcomeAdjustmentsResults
Barber and Robinson68 Exposure Self-reported racial discrimination during the 12 months before the new baby was born All participants, OR (95%CI)
Race/ethnicity /ethnicity, age, income, health insurance statusLBW: 2.27 (1.18 to 4.38)
Race/ethnicity, age, educationPTB: 1.76 (0.90 to 3.43)
Race/ethnicity, education, income, marital statusSGA: 1.31 (0.70 to 2.45)
Non-Hispanic white, OR (95%CI)
Age, education, income, health insurance status, marital statusLBW: 0.30 (0.08 to 1.14)
Outcome LBW (<2500 g), PTB (<37 weeks gestation), SGA (based on 10th percentile)Age, education, income, and marital statusPTB: 0.13 (0.03 to 0.61)
Age, education, income, health insurance status, marital status, smoking during pregnancySGA: 1.47 (0.42 to 5.13)
Non-Hispanic black, OR (95% CI)
Age, income, health insurance statusLBW: 3.56 (1.28 to 9.91)
Age, education, income, drinking during pregnancy, gestational diabetesPTB: 7.18 (2.28 to 22.65)
Age, income, drinking during pregnancySGA: 1.95 (0.55 to 6.87)
Brown et al 201959 Exposure Self-reported racism and discrimination in perinatal care OR (95% CI), crude
NALBW: 2.1 (1.1 to 4.1)
NAPTB: 1.0 (0.5 to 1.9)
NAHBW: 0.8 (0.4 to 1.8)
NASGA: 2.0 (1.1 to 3.6)
NALGA: 1.0 (0.4 to 2.4)
Model 1, OR (95% CI)
ParityLBW: 2.1 (1.1 to 4.1)
ParityHBW: 0.8 (0.4 to 1.8)
ParityPTB: 1.0 (0.5 to 1.9)
ParitySGA: 2.0 (1.1 to 3.6)
ParityLGA: 1.0 (0.4 to 2.4)
Outcome LBW (<2500 g), PTB (birth <37 weeks gestation), SGA Model 2, OR (95%CI)
Parity, use of cigarettes and/or cannabis during pregnancyLBW: 1.9 (1.0 to 3.8)
Parity, use of cigarettes and/or cannabis during pregnancyHBW: 0.9 (0.4 to 1.9)
Parity, use of cigarettes and/or cannabis during pregnancyPTB: 1.0 (0.5 to 1.9)
Parity, use of cigarettes and/or cannabis during pregnancySGA: 1.9 (1.0 to 3.5)
Parity, use of cigarettes and/or cannabis during pregnancyLGA: 1.0 (0.4 to 2.5)
Model 3, OR (95%CI)
Parity, stressful events and stressful events/social health issuesLBW: 2.0 (1.0 to 3.9)
Parity, stressful events and stressful events/social health issuesHIB: 0.8 (0.3 to 1.7)
Parity, stressful events and stressful events/social health issuesPTB: 1.1 (0.5 to 2.1)
Parity, stressful events and stressful events/social health issuesSGA: 1.7 (0.9 to 3.2)
Parity, stressful events and stressful events/social health issuesLGA: 0.9 (0.4 to 2.2)
Dixon et al 201255 Exposure Self-reported racism during their lifetime Birth weight for gestational age z-score, overall, Model 1
Maternal age, race/ethnicity, child sex, age at outcome1–2 racism domains: −0.04 (−0.24 to 0.15)
3+ racism domains: −0.18 (−0.38 to 0.01)
Birth weight for gestational age z-score, overall, Model 2
Maternal age, race/ethnicity, child sex, age at outcome, maternal nativity, education, pregnancy BMI, household income1–2 racism domains: −0.11 (−0.31 to −0.09)
3+ racism domains: NA
Birth weight for gestational age z-score, black, Model 1
Maternal age, race/ethnicity, child sex, age at outcome1–2 racism domains: 0.00 (−0.29 to 0.28)
3+ racism domains: 0.00 (−0.27 to 0.27)
Birth weight for gestational age z-score, black, Model 2
Maternal age, race/ethnicity, child sex, age at outcome, maternal nativity, education, pregnancy BMI, household income1–2 racism domains: −0.01 (−0.31 to 0.28)
3+ racism domains: −0.05 (−0.34 to 0.23)
Outcome Birth weight for gestational age Birth weight for gestational age z-score, Hispanic, Model 1
Maternal age, race/ethnicity, child sex, age at outcome1–2 racism domains: −0.04 (−0.41 to 0.34)
3+ racism domains: −0.52 (−0.95 to −0.10)
Birth weight for gestational age z-score, Hispanic, Model 2
Maternal age, race/ethnicity, child sex, age at outcome, maternal nativity, education, pregnancy BMI, household income1–2 racism domains: −0.25 (−0.63 to 0.14)
3+ racism domains: −0.70 (−1.13 to −0.26)
Birth weight for gestational age z-score, Asian, Model 1
Maternal age, race/ethnicity, child sex, age at outcome1–2 racism domains: −0.07 (−0.46 to 0.33)
3+ racism domains: −0.18 (−0.66 to 0.30)
Birth weight for gestational age z-score, Asian, Model 2
Maternal age, race/ethnicity, child sex, age at outcome, maternal nativity, education, pregnancy BMI, household income1–2 racism domains: −0.11 (−0.51 to 0.30)
3+ racism domains: −0.21 (−0.70 to 0.27)
Dominguez et al 201067 Exposure Self-reported lifetime and childhood-vicarious racismGestational age, medical risk, spontaneous labour, clinic patient, parent’s education Hierarchical linear regression models racism as predictors of birth weight
Lifetime (β) gestational age, African-American
−0.28
Outcome LBW <2500 g, birth weight (g), gestational age at delivery, PTB (birth <37 weeks gestation) Childhood-vicarious (β), African-American
−0.01
Lifetime (β) gestational age, non-Hispanic white
−0.26*
Childhood-vicarious (β), non-Hispanic white
−0.07
Janevic et al 201764 Exposure Self-reported interpersonal racism during daily life
Outcome LBW <2500 g
LBW, RR (95%CI)
NACrude: 2.1 (1.0 to 4.2)
Age, parity, years at current residence, household wealth indexModel 1: 2.4 (1.1 to 5.2)
Age, parity, years at current residence, household wealth index, institutional discrimination measuresModel 2: 2.5 (1.0 to 5.9)
Mustillo et al 200449 Exposure Self-reported racial discrimination during their lifetime
Outcome LBW (<2500 g), PTB (birth <37 weeks gestation)
LBW, OR (95% CI), Model 6
Race/ethnicity1–2 racism domains: 2.04 (0.50 to 8.31)
3+ racism domains: 4.81 (1.50 to 15.40)
LBW, OR (95% CI), Model 8
Race/ethnicity, smoking status, alcohol use, depressive symptomatology, education, income, pregnancy net wain gain1–2 racism domains: 1.96 (0.51 to 7.56)
3+ racism domains: 4.98 (1.43 to 17.39)
LBW, OR (95% CI), Model 9
Race/ethnicity, smoking status, alcohol use, depressive symptomatology, education, income, pregnancy net wain gain, gestational age1–2 racism domains: 1.06 (0.29 to 3.84)
3+ racism domains: 1.56 (0.32 to 7.76)
PTB, OR (95% CI), Model 2
Race/ethnicity1–2 racism domains: 1.97 (0.89 to 4.38)
3+ racism domains: 2.42 (1.03 to 5.69)
PTB, OR (95% CI), Model 4
Race/ethnicity, smoking status, alcohol use, depressive symptomatology, education, income1–2 racism domains: 2.05 (0.93 to 4.50)
3+ racism domains: 3.05 (1.29 to 7.24)
Rankin et al 201161 Exposure Self-reported racial discrimination during lifetime and past year
Outcome LBW (<2500 g), PTB (birth <37 weeks gestation)
NA LBW-PTB, OR (95% CI), crude
High lifetime: 1.5 (0.9 to 2.8)
High past-year: 2.5 (1.2 to 5.2)
Thayer et al 201953 Exposure Self-reported racial discrimination across the lifetime and past year.
Outcome Birth weight, gestational age
Birth weight, β coeff (95% CI), Māori Birth weight, β coeff (95% CI), Pacific Birth weight, β coeff (95% CI), Asian
Maternal age, education, relationship status, smoking, BMI, offspring sex, household incomeAny personal attack: −84.7 (−190 to 20.9)Any personal attack: 24.8 (−109 to 159)Any personal attack: 75.7 (−16.1 to 167)
UT health: −13.0 (−166 to 140)UT health: 142 (−46.7 to 330)UT health: 4.98 (−194 to 204)
UT work: −243 (−425 to −60.2)UT work: 137 (−46.7 to 321)UT work: 49.2 (−66.0 to 164)
UT housing: −146 (−286 to −5.93)UT housing: 15.1 (−177 to 207)UT housing: 188 (7.04 to 369)
UT criminal system: −95.8 (−255 to 64.0)UT criminal system: 138 (−91.6 to 369)UT criminal system: 2.12 (−295 to 299)
UT banking: −122 (−333 to 89.7)UT banking: 246 (−34.4 to 527)UT banking: 119 (−314 to 553)
UT education: −63.9 (−193 to 65.7)UT education: 79.9 (−108 to 268)UT education: −86.6 (−239 to 66.3)
Gestational length, β coeff (95% CI), Māori Gestational length, β coeff (95% CI), Pacific Gestational length, β coeff (95% CI), Asian
Maternal age, education, relationship status, smoking, BMI, offspring sex, household incomeAny personal attack: −0.18 (−0.53 to 0.16)Any personal attack: 0.29 (−0.12 to 0.70)Any personal attack: 0.13 (−0.15 to 0.42)
UT health: −0.36 (−0.87 to 0.15)UT health: 0.25 (−0.32 to 0.84)UT health: −0.26 (−0.88 to 0.36)
UT work: −0.95 (−1.56 to −0.34)UT work: −0.40 (−0.60 to 0.52)UT work: 0.18 (−0.17 to 0.55)
UT housing: −0.20 (−0.67 to 0.26)UT housing: 0.09 (−0.50 to 0.69)UT housing: 0.30 (−0.26 to 0.87)
UT criminal system: −0.55 (−1.08 to −0.02)UT criminal system: 0.51 (−0.19 to 1.22)UT criminal system: 0.45 (−0.47 to 1.39)
UT banking: −0.73 (−1.43 to −0.02)UT banking: 0.64 (−0.21 to 1.51)UT banking: 0.33 (−1.02 to 1.70)
UT education: −0.24 (−0.67 to 0.18)UT education: 0.18 (−0.39 to 0.76)UT education: −0.31 (−0.79 to 0.16)
Collins et al 200062 Exposure Self-reported racial discrimination during pregnancy
Outcome VLBW (<1500 g)
VLBW, OR (95% CI)
NACrude: 1.9 (0.5 to 6.6)
Maternal age, parity, social supportModel 1: 2.1 (0.7 to 6.1)
Smoking, alcohol, drug useModel 2: 5.2 (1.2 to 22.0)
Maternal age, parity, social support, smoking, alcohol, drug useModel 3: 3.3 (0.9 to 11.3)
Collins et al 200463 Exposure Self-reported racial discrimination during pregnancy and lifetime
Outcome VLBW (<1500 g), PTB (birth <37 weeks gestation)
VLBW PTB, OR (95% CI), lifetime discrimination, crude
NA≥1 domain: 1.9 (1.2 to 3.1)
≥2 domains: 2.1 (1.2 to 3.8)
≥3 domains: 3.2 (1.5 to 6.6)
VLBW PTB, OR (95% CI), discrimination during this pregnancy, crude
NA≥1 domain: 0.9 (0.5 to 1.7)
≥2 domains: 1.5 (0.5 to 4.4)
≥3 domains: NA
VLBW PTB, OR (95% CI), lifetime discrimination
Maternal age, education, cigarette smoking≥1 domain: 1.7 (1.0 to 9.2)
≥3 domains: 2.6 (1.2 to 5.3)
Lespinasse et al 200460 Exposure Self-reported racial discrimination Outcome VLBW (<1500 g) VLBW PTB, OR (95% CI)
NA1+ domain: 1.9 (1.2 to 3.0)
3+ domains: 2.7 (1.3 to 5.4)
Braveman et al 201736 Exposure Self-reported chronic worry about racial discrimination PTB, PR (95% CI), US-born black
NACrude: 1.73 (1.12 to 2.67)
Maternal age, parity, marital status, family income, maternal education, % of census-tract residents with income below poverty, number of major stressors during pregnancy, depressive symptoms during pregnancyModel 1: 1.95 (1.27 to 2.97)
Maternal age, parity, marital status, family income, maternal education, % of census-tract residents with income below poverty, number of major stressors during pregnancy, depressive symptoms during pregnancy, smoked 3 months before pregnancy, binge drank while pregnant, unintended pregnancy, lack first-trimester prenatal care, interpregnancy interval, self-reported health pregnancy, diabetes, hypertension, underweight diagnoses before pregnancy, inadequate pregnancy weight gainModel 2: 2.00 (1.33 to 3.01)
PTB, OR (95% CI), US-born black, crude*
NA1.45 (1.1 to 1.9)*
Outcome PTB (17–36 weeks gestation) PTB, PR (95% CI), US-born white
NACrude: 1.77 95% CI (0.83 to 3.77)
Maternal age, parity, marital status, family income, maternal education, % of census-tract residents with income below poverty, number of major stressors during pregnancy, depressive symptoms during pregnancyModel 1: 1.67 (0.73 to 3.79)
Maternal age, parity, marital status, family income, maternal education, % of census-tract residents with income below poverty, number of major stressors during pregnancy, depressive symptoms during pregnancy, smoked 3 months before pregnancy, binge drank while pregnant, unintended pregnancy, lack first-trimester prenatal care, interpregnancy interval, self-reported health pregnancy, diabetes, hypertensionModel 2: 1.84 (0.91 to 3.71)
Daniels et al 202065 Exposure Self-reported direct and vicarious racial discrimination across three life stages (adult, adolescent, childhood) PTB, OR (95% CI), crude
NAAdult direct: 1.056 (0.888 to 1.257)
Adult vicarious: 1.140 (0.893 to 1.455)
Adolescent direct: 1.488 (1.006 to 2.202)
Adolescent vicarious: 1.265 (0.982 to 1.628)
Childhood direct: 1.086 (0.800 to 1.473)
Childhood vicarious: 1.449 (0.999 to 2.102)
Outcome PTB (birth <37 weeks gestation) PTB, OR (95%CI)
Number of pregnancies, income adjusted for household size, college educated, employed, marital statusAdult direct: 1.091 (0.914 to 1.302)
Adult vicarious: 1.131 (0.883 to 1.448)
Adolescent direct: 1.480 (1.002 to 2.187)
Adolescent vicarious: 1.271 (0.986 to 1.637)
Childhood direct: 1.100 (0.808 to 1.498)
Childhood vicarious: 1.453 (1.010 to 2.092)
Dole et al 200356 Exposure Self-reported racial discrimination PTB, RR (95% CI), crude
NASome discrimination: 0.8 (0.6 to 1.2)
Higher discrimination: 1.4 (1.0 to 1.9)
Outcome PTB (birth <37 weeks gestation) PTB, RR (95%CI)
Parity, poverty indexSome discrimination: 0.9 (0.6 to 1.4)
Higher discrimination: 1.4 (1.0 to 2.0)
Dole et al 200457 Exposure Self-reported racial discrimination
Outcome Preterm birth (birth <37 weeks gestation)
PTB, RR (95% CI), African-American
BMI, heightSome discrimination: 1.1 (0.6 to 2.1)
High discrimination: 1.8 (1.1 to 2.9)
PTB, RR (95% CI), white
Some discrimination: 0.8 (0.4 to 1.4)
High discrimination: NA
Fryer et al 202039 Exposure PTB, HR (95% CI), African-American, crude
NALow: 0.8 (0.4 to 1.7)
Medium: 1.5 (0.8 to 2.9)
High: 1.4 (0.7 to 2.7)
PTB HR 95% CI, African-American
Geographic locationLow: 0.9 (0.4 to 1.9)
Medium: 1.6 (0.8 to 3.2)
High: 1.5 (0.7 to 3.1)
Outcome PTB (spontaneous birth <37 weeks gestation) PTB HR 95% CI, Latina, crude
NALow: 4.1 (1.1 to 14.6)
Medium: 4.0 (1.1 to 15.2)
High: 3.8 (0.9 to 15.1)
PTB, HR (95% CI), Latina
Geographic locationLow: 3.6 (0.99 to 13.2)
Medium: 4.1 (1.1 to 15.5)
High: 3.6 (0.9 to 14.4)
PTB, OR (95% CI), African-American, crude *
NAHigh: 1.40 (0.68 to 2.85)*
PTB, OR (95% CI), Latina, crude *
NAHigh: 3.82 (0.94 to 15.64)*
Giurgescu et al 201266 Exposure Self-reported racial discrimination over the lifetime
Outcome PTB (birth <37 weeks gestation)
Objective physical disorder, objective social disorder, violent crime, perceived physical disorder, perceived social disorder, perceived crime, EOD situation, EOD frequency, psychological distress PTB, OR (95% CI), crude
EOD situation: 0.810 (0.50 to 1.32)
EOD frequency: 1.105 (0.93 to 1.31)
Misra et al 201038 Exposure Self-reported racism over lifetime Outcome PTB (birth <37 weeks gestation) Gestational ageNA PTB, HR (95%CI), crude
Above median RALES: 1.00 (0.70 to 1.44)
Top quartile in RALES: 0.88 (0.58 to 1.35)
PTB, OR (95%CI), crude*
Top quartile in RALES: 0.88 (0.58 to 1.35)*
Rosenberg et al 200250 Exposure Self-reported racial discrimination in daily life
Outcome PTB (birth <37 weeks gestation)
PTB, OR (95% CI), crude
NAUnfair treatment at job: 1.3 (1.1 to 1.7)
Unfair treatment in housing: 1.0 (0.8 to 1.3)
Unfair treatment by police: 1.2 (0.9 to 1.5)
People acting afraid of them at least once a week: 1.4 (1.0 to 2.0)
PTB, OR (95% CI)
Age of mother at birth, parity, marital status, previous preterm birth, mother born three or more weeks early, smoked during the pregnancy, years of educational attainmentUnfair treatment at job: 1.3 (1.1 to 1.6)
Unfair treatment in housing: 1.0 (0.8 to 1.3)
Unfair treatment by police: 1.1 (0.9 to 1.4)
People acting afraid of them at least once a week: 1.4 (1.0 to 1.9)
Scholaske et al 201951 Exposure Frequency of self-reported racial discrimination in last year or within the last 2 years
Outcome PTB (birth <37 weeks gestation)
PTB, OR (95% CI), crude
NASeldom/often: 4.25 (1.68 to 11.56)
PTB, OR (95% CI)
Infant sex, maternal age, parity, years of educationSeldom/often: 5.76 (1.95 to 19.38)
Slaughter-Acey et al 201637 Exposure Self-reported racial discrimination during the index pregnancy and up to 1 year before the pregnancy
Outcome PTB (birth <37 weeks gestation)
NA PTB, PR 95% (CI), crude
Second quartile: 1.67 (1.16 to 2.40)
Third quartile: 1.32 (0.90 to 1.94)
Fourth quartile: 1.19 (0.81 to 1.76)
PTB, OR (95% CI), crude *
Second quartile: 1.85 (1.20 to 2.85)*
Third quartile: 1.4 (0.89 to 2.18)*
Fourth quartile: 1.23 (0.78 to 1.93)*
Wheeler et al 201854 Exposure Self-reported racism during lifetime and pregnancy
Outcome PTB (spontaneous birth <37 weeks gestation)
PTB, OR (95% CI)
Age, race, medical illness, psychiatric illness, tobacco useEntire cohort: 1.06 (0.90 to 1.25)
Primiparous: 1.29 (0.91 to 1.83)
Multiparous prior term birth: 1.01 (0.79 to 1.30)
Multiparous prior PTB: 1.05 (0.78 to 1.40)
Slaughter-Acey et al 201952 Exposure Self-reported overall racism during lifetime SGA, OR (95% CI), crude
NAOverall: 0.95 (0.82 to 1.10)
Personal: 0.92 (0.74 to 1.13)
Group: 0.97 (0.73 to 1.30)
SGA, OR (95% CI), ≥25 years
Maternal education, Medicaid status, essential money, parity, recruitment statusOverall: 0.92 (0.66 to 1.28
Personal: 0.96 (0.58 to 1.58)
Group: 0.83 (0.47 to 1.45)
Outcome SGA (using the cut point defined for the BW ratio continuous measure) SGA, OR (95% CI), 19–24 years
Maternal education, Medicaid status, essential money, parity, recruitment statusOverall: 0.86 (0.69 to 1.06)
Personal: 0.86 (0.64 to 1.18)
Group: 0.72 (0.47 to 1.10)
SGA, OR (95% CI), ≤18 years
Maternal education, Medicaid status, essential money, parity, recruitment statusOverall: 1.45 (1.02 to 2.08)
Personal: 1.33 (0.86 to 2.09)
Group: 2.84 (1.10 to 7.32)
Grobman et al 201858 Exposure Self-reported racism
Outcome PTB (birth <37 weeks gestation), HDP, SGA
OR (95% CI), non-Hispanic black
Maternal age, BMI, smoking, medical comorbiditiesAny PTB: 1.31 (1.04 to 1.64)
iPTB: 1.39 (1.00 to 1.93)
sPTB: 1.21 (0.90 to 1.63)
HDP: 0.98 (0.81 to 1.20)
SGA: 2.07 (1.69 to 2.53)
OR (95% CI), Hispanic
Maternal age, BMI, smoking, medical comorbiditiesAny PTB: 0.95 (0.76 to 1.20)
iPTB: 0.93 (0.65 to 1.33)
sPTB: 0.95 (0.71 to 1.27)
HDP: 0.71 (0.58 to 0.86)
SGA: 1.45 (1.19 to 1.77)
OR (95% CI), Asian
Maternal age, BMI, smoking, medical comorbiditiesAny PTB: 0.87 (0.56 to 1.36)
iPTB: 0.80 (0.37 to 1.74)
sPTB: 0.91 (0.54 to 1.53)
HDP: 0.82 (0.56 to 1.20)
SGA: 2.08 (1.54 to 2.81)
OR (95% CI), other
Maternal age, BMI, smoking, medical comorbiditiesAny PTB: 1.14 (0.82 to 1.59)
iPTB: 1.00 (0.59 to 1.68)
sPTB: 1.23 (0.81 to 1.85)
HDP: 0.85 (0.63 to 1.14)
SGA: 1.42 (1.05 to 1.93)
  • *These unadjusted ORs were computed with the available information in the study.

  • BMI, body mass index; EOD, experience of discrimination; HBW, high birth weight; HDP, hypertensive disorder of pregnancy; LBW, low birth weight; LGA, large for gestational age; PR, prevalence ratio; PTB, preterm birth; RR, relative risk/risk ratio; SGA, small for gestational age; UT, unfair treatment; VLBW, very low birth weight.