Table 1

Summary characteristics of included documents

StudyStudy designCountryPopulationPregnancy typeRace or ethnicity includedAscertainment racial discriminationOutcomeAscertainment outcome
Barber and Robinson68 Cross-sectional studyUSANo of participants: 2634
Age range: 15–44
Women part of the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) recruited from 47 states, New York City, Puerto Rico and the District of Columbia
NRNon-Hispanic black, non-Hispanic white, Hispanic, non-Hispanic otherAnswer to a self-reported question on the PRAMS questionnairePTB (<37 weeks’ gestation)
LBW (<2500 g)
SGA (based on 10th percentile)
Birth certificate data
Brown et al 201959 Cohort studyAustraliaNo of participants: 344 (165 reporting discrimination or unfair treatment)
Mean age: 25 (range 15–43)
Women were recruited in urban, regional and remote areas of South Australia over 2 years. Twelve Aboriginal research interviewers recruited women via public hospitals, community-based agencies, community events and their own community networks. To be eligible to take part, women needed to have given birth to an Aboriginal infant in South Australia between June 2011 and July 2013, and to be aged ≥14 years at the time of the birth
NRAboriginalAdapted questions of Indigenous Racism Experience questionnaire
(adapted from Paradies et al)103
LBW (<2500 g), PTB (birth <37 weeks gestation), SGADid not report; Australian birth weight standards
Dixon et al 201255 Cohort studyUSANo of participants: 539 mother–infant pairs (176 reporting 1–2 domains of racism, 187 ≥3)
Mean age: 30 (5.8)
Subjects were participants in Project Viva, a prospective cohort study of gestational factors, pregnancy outcomes and offspring health. Between 1999 and 2002 women who attended their initial prenatal visit at eight obstetric offices of a multi-specialty group practice in eastern Massachusetts were recruited
SingletonBlack, Hispanic, Asian, otherAdapted or expanded Experiences of Discrimination scale measuring lifetime racial discrimination
(from Krieger et al, 1990,104 2005)105
Birth weight for gestational ageUS national reference data; length and height measurements performed by research assistants following standardised techniques
Dominguez et al 201067 Cross-sectional studyUSANo of participants: 124
Mean age: 28.65 (5.14)
African American, 31.43 (4.07) non-Hispanic white
Approached by a research nurse in the prenatal clinic of a large urban medical centre in Los Angeles County or referred by private practitioners with admitting privileges to this medical centre.
To be eligible, potential participants had to be ≥18 years, fluent in English, and at no more than 18 weeks gestation with a singleton pregnancy
SingletonAfrican-American, non-Hispanic whiteAnswer to a self-reported question on perceived racism
(loosely based on items from Krieger et al)104
Birth weight (g), gestational age at delivery, LBW, preterm deliveryMedical records
Janevic et al 201764 Cross-sectional studySerbia, MacedoniaNo of participants: 410 women (top 25% on EDS were experiencing discrimination)
Age: <20: 73; 20–24: 168; 25–29: 106; ≥30: 63
Romani women in Belgrade, Serbia and Skopje, North Macedonia in 2012–2013 who had given birth in the previous 2 years
NRRomaniEveryday Discrimination Scale
(developed by Williams et al)106
LBW (<2500 g)Self-report
Mustillo et al 200449 Cohort studyUSANo of participants: 352 (171 experiencing racism)
Mean age: 33.1 (3.3) black women, 34.8 (3.2) white women
From original 1985 prospective cohort study CARDIA, recruited from four geographically diverse metropolitan areas. Participants who gave birth between 1992 and 1995 were eligible
SingletonBlack, whiteSelf-reported experiences of racial discrimination based on Krieger’s Experiences of Discrimination scale
(from Krieger et al)104
LBW (<2500 g), preterm deliveries (<37 weeks gestation)Self-report (at year 10)
Thayer et al 201953 Cohort studyNew ZealandNo of participants: 1653 (ever verbal attack 427, ever physical attack 59, unfair treatment 498)
Mean age: 29.5 (5.6)
Sample from Growing Up in New Zealand (GUINZ) study recruiting pregnant women who had an estimated birth date between 25 April 2009 and 25 March 2010 and living within geographic area defined by Auckland, Counties-Manukau or Waikato District Health Board regions in the North Island of Aotearoea, New Zealand.
SingletonMāori, Pacific and AsianQuestionnaire asking about lifetime and past experience of unfair treatment
(Growing Up in New Zealand questionnaire)107
LBW (<2500 g), short gestation length (37 weeks gestation)Medical records
Collins et al 200062 Case–control studyUSANo of participants: 85 (25 cases, 60 controls)
Age: no overall statistic clearly reported
Subjects were recruited from Children’s Memorial Hospital (neonatal intensive care unit) and Cook County Hospital (neonatal intensive unit, normal newborn nursery) in Chicago
SingletonAfrican-AmericanQuestionnaire on perception and exposure to racial discrimination during pregnancy
(from Krieger et al)104
VLBW (<1500 g)Medical records
Collins et al 200463 Case–control studyUSANo of participants: 312 (104 cases, 208 controls)
Age: no overall statistic clearly reported
Mothers delivering at Cook County Hospital and University of Chicago Hospital in Chicago between 1 November 1997 and 31 October 2000. Cases: mothers of singleton births with VLBW infants and preterm. Controls: mothers of critically ill, singleton non-LBW term infants admitted to neonatal ICU or healthy singleton non-LBW infants admitted to newborn nursery
SingletonAfrican-AmericanQuestionnaire on perception and exposure to racial discrimination during pregnancy
(adapted from Krieger et al 104 and McNeilly et al)108
VLBW (<1500 g), PTB (<37 weeks gestation)Medical records
Lespinasse et al 200460 Case–control studyUSANo of participants: 312 women (141 reporting racial discrimination)
Age: <19: 82; 19–29: 156; ≥30: 64
Cases were 104 mothers of VLBW infants recruited from the admission logbooks of the NICUs of Cook County Hospital and the University of Chicago Hospital.
Controls were 104 mothers of NBW; healthy infants (‘healthy controls’); and 104 mothers of NBW, sick infants who required assisted ventilation or other major life support (‘sick controls’). Healthy controls were recruited from the labour and delivery logbooks and were chosen if admitted near the same date as the cases; sick controls were identified from NICU logbook
SingletonAfrican-AmericanQuestionnaire that included questions on racismVLBW (<1500 g)Medical records
Braveman et al 201736 Cross-sectional studyUSANo of participants: 10 323 women (812 black women (36.9%) reporting chronic worry from discrimination, 446 white women (5.5%))
Age: >15
California Maternal and Infant Health Assessment (MIHA)
Cross-sectional California statewide representative surveys of 2201 black and 8122 white, non-Latino, US-born postpartum women with singleton live births during 2011–2014. The MIHA sample is drawn randomly from statewide birth certificate data each year
SingletonBlack, white non-LatinoQuestionnaire asking about chronic worry for race-based unfair treatmentPTB (17–36 weeks of gestation)Birth certificate information and National Centre for Health Statistics criteria; obstetric estimate or LMP for GA
Daniels et al 202065 Cross-sectional studyUSANo of participants: 173
Age range: 30–50
US-born, post-partum women from African-AmericanWomen’s Heart & Health Study (AAWHHS), which includes detailed health information on a community sample of 208 African-American women aged 30–50 residing in the San Francisco Bay Area
NRAfrican-AmericanAdapted Everyday Discrimination Scale, adapted a scale
(adopted from Krieger et al)105
Preterm labour (<37 weeks gestation)Self-report
Dole et al 200356 Cohort studyUSANo of participants: 1962 (574 reporting some or higher discrimination)
Age range: 16–19: 274; 20–29: 1036; ≥30: 652
The Pregnancy, Infection, and Nutrition Study, a prospective cohort study of risk factors for PTB, recruited women from two prenatal clinics in central North Carolina who were between 24 and 29 weeks’ gestation, beginning in August 1995
SingletonAfrican-AmericanPsychological self-reported questionnaire
(adapted from Krieger,104 Krieger and Sidney)109
PTB (<37 weeks gestation)Medical records
Dole et al 200457 Cohort studyUSANo of participants: 1898 (364 black women reporting discrimination, 271 white women)
Age range: 16–19: 261; 20–29: 1002; ≥30: 635
The Pregnancy, Infection, and Nutrition (PIN) Study was conducted in central North Carolina at two prenatal care sites (>16 years of age, between 24 and 29 weeks gestation. Self-reported white or African American).
SingletonAfrican-American, whiteAdapted Experience of Discrimination Scale (Krieger)
(adapted from Krieger104 Krieger and Sidney)109
PTB (<37 weeks gestation)Medical records; algorithm using LMP or earliest US before 20 weeks
Fryer et al 202039 Cohort studyUSANo of participants: 1732 (736 reporting medium or high discrimination)
Mean age: 24.2 (5.0) non-Hispanic African American, 25.7 (5.2) Latina
Community Child Health Research Network Study, a 5-year, multisite, prospective cohort study. Women were recruited from Baltimore, Chicago, North Carolina, Los Angeles and Washington DC from 2008 to 2012 and followed up over a 2-year period. 18–40 years of age
SingletonAfrican-American, LatinaEveryday Discrimination Scale
(developed by Williams et al)106
Spontaneous preterm delivery (<37 weeks)Medical records
Giurgescu et al 201266 Cross-sectional studyUSANo of participants: 72 (no reporting discrimination not reported)
Mean age: 23.38 (5.44) full term, 23.27 (5.24) preterm
African-American women ≥18 years old, at least 24 weeks gestation at birth, at least 24 hours after birth and medically stable in Chicago hospital. Excluded if had medical comorbidity, unstable or had medically indicated birth
SingletonAfrican-AmericanAdapted Experiences of Discrimination scale
(adapted from Krieger et al, 1990,104 2010110
PTB (<37 weeks gestation)Medical records based on LMP and confirmed by US
Misra et al 201038 Cohort studyUSANo of participants: 832 (425 experiencing racism)
Mean age: 23.1 (5.6)
African-American women residing in Baltimore, Maryland, enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution (JHMI) prenatal clinics or enrolled post-partum if they delivered at JHMI with late, none or intermittent prenatal care
SingletonBlack or African-American, HispanicRacism and Lifetime Experiences Scale (RaLES), RaLES Daily Life Experiences Scale (DLE), Racism‐Related Experiences Scale (RRE)
(from Harrell et al)111
PTB (<37 weeks gestation), gestational ageMedical records
Rankin et al 201161 Case–control studyUSANo of participants: 277 (160 cases, 117 controls)
Age: <20: 60; 20–34: 186; ≥35: 31
African-American mothers delivering at Stroger Hospital of Cook County and Unversity of Chicago Hospital in Chicago, IL between July 2001 and June 2005
SingletonAfrican-AmericanAdapted Perceived Racism Scale
(adapted from McNeilly et al)108
PTB (<37 weeks gestation) LBW (<2500 g)Medical records
Rosenberg et al 200250 Cohort studyUSANo of participants: 4966
Age range: 21–69
Follow-up study from Black Women’s Health Study (1995) recruiting US African-American women. Those completing 1997–1999 questionnaires and reported singleton birth were eligible
SingletonAfrican-AmericanNine questions regarding their experience of racial discriminationPTB (<37 weeks gestation)Self-report
Scholaske et al 201951 Cohort studyGermanyNo of participants: 2515 (46 experiencing racism)
Mean age: 31.43 (5.44) German autochthonous, 30.71 (5.68) Turkish immigrant women
Sample from German Socio-Economic Panel (SOEP) study of German autochthonous and Turkish immigrant women who recently gave birth, within first year after delivery
SingletonGerman autochthonous
Self-report: single item asking frequency of perceived discriminationPTB (<37 weeks gestation)Self-report (from newborn questionnaire)
Slaughter-Acey et al 201637 Cohort studyUSANo of participants: 1232 women (DLE-B score second quartile 305, third 307, fourth 315)
Age range: 21–69
Sample from the Life-course Influences of Fetal Environments (LIFE) study which recruited black or African-American women aged 18–45 years who gave birth to a singleton at a surburban hospital in metropolitan Detroit
SingletonBlack or African-AmericanRaLES Daily Life Experiences Scale (DLE) scale of Racism and Bother
(from Harrell et al)111
PTB (<37 weeks gestation)Medical records; algorithm to estimate GA (based on early US, LMP, later US or clinician’s estimate)
Wheeler et al 201854 Cohort studyUSANo of participants: 1606 women (1256 black, 350 white)
Mean age: primiparous: 23.5 (5.8); multiparous term birth: 26.7 (6.2); multiparous PTB: 27.7 (5.6)
English-speaking pregnant women enrolled in Healthy Pregnancy, Healthy Baby Study in Durham, North Carolina, USA. Participants received their care at the Duke Obstetrics Clinic of the Durham County Health Department Prenatal Care
SingletonNon-Hispanic black, non-Hispanic whitePerceived Racism Scale
(from Dole et al,57 adopted Krieger et al 104 and Krieger and Sidney)109
PTB (spontaneous)Medical records; enrolment interview
Slaughter-Acey et al 201952 Cohort studyUSANo of participants: 778 (730 acknowledged at least one item of racism, 48 did not acknowledge any item)
Mean age: 23.3 (5.7)
Black or African-American women living in Baltimore City, Maryland who attended JHMI satellite prenatal clinic or delivered a live infant at JHMI
NRBlack or African-AmericanAdapted Racism and lifetime Experience Scale (RaLES)
(from Harrell et al)111
SGASGA determined using cut-off point for birth weight ratio continuous measure (observed birth weight divided by expected birth weight for infant’s GA)
Grobman et al 201858 Cohort studyUSANo of participants: 9470 women (N reporting racial discrimination not reported)
Age: no overall statistic clearly reported
The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be is a prospective cohort study in which 10 038 nulliparous women (>13 years of age) with singleton pregnancies were enrolled from geographically diverse hospitals affiliated with eight clinical centres
SingletonNon-Hispanic white, non-Hispanic black, Hispanic, Asian, otherKrieger Racism Scale
(developed by Krieger et al)105
Hypertensive disorder of pregnancy, SGA, PTB (<37 weeks gestation)Medical records
  • GA, gestational age; LBW, low birth weight; LMP, last menstrual period; NICU, newborn intensive care unit; NR, not reported; PTB, preterm birth; SGA, small for gestational age; US, ultrasound; VLBW, very low birth weight.