Maternal experiences with everyday discrimination and infant birth weight: a test of mediators and moderators among young, urban women of color

Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism

BACKGROUND

Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure.

METHODS

We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers.

RESULTS

In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile.

CONCLUSION

ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.

"They Don't Respect Black Women": Narrating a Young Black Woman's Harrowing Birthing Experience

Black women tend to feel underserved due to the lack of culturally competent care and support from healthcare systems. In particular, the combination effects of racial discrimination, inadequate prenatal care, and pregnancy complications contribute to the increased risks of stress and trauma among Black pregnant women. Though the literature has documented the challenges that Black women face in the healthcare system, in-depth narratives of birthing experiences may provide a better understanding of these issues. In this paper, we used a qualitative approach to describe the case study of a 30-year-old Black American woman who had a harrowing birthing experience. We conducted an individual interview with the participant upon her request. Six key themes were derived from her narrative that summarized her birthing experience: healthcare provider miscommunication, lack of control, trauma experience, interpersonal racism, systemic racism, and internalized racism. The participant had a birthing experience that she felt "could not go untold." The discomfort and disrespect she experienced appear not to be uncommon in a considerable number of Black women of reproductive age. There is a need for healthcare providers to be trained to provide culturally appropriate care to Black women. In addition, healthcare providers need to treat Black women absent of prior stereotypes or biases to contribute to more effective care. Employing such treatment may improve Black women's reproductive health-seeking behavior as well as maternal and child health.

Experiences of discrimination during pregnancy predict altered neonatal hair cortisol at birth

OBJECTIVE

Prenatal glucocorticoids (e.g., cortisol) are a widely proposed prenatal programming mechanism, yet few studies directly measure fetal cortisol. Neonatal hair provides a non-invasive method to assess fetal cortisol. The current studies test the association between maternal exposure to discrimination and fetal cortisol, as measured in neonatal hair, in two cohorts.

METHODS

Study 1: Pregnant individuals (N = 65) and their neonates (61.8 % female) participated in study 1 between 2017 and 2021. Participants self-identified as Asian (6.2 %), Black (21.5 %), Latinx (35.4 %), Multiracial or Multiethnic (35.4 %), and Native Hawaiian or Pacific Islander (1.5 %). Experiences of discrimination were measured using the Everyday Discrimination Scale. Neonatal hair samples were collected close to birth (Mediandays=1.30, IQRdays=0.96-2.03).

RESULTS

Study 1: Higher experiences of everyday discrimination among pregnant individuals were associated with lower hair cortisol levels in neonates (r = -.28, p = .031).

METHODS

Study 2: Pregnant individuals of Mexican descent (N = 73) and their neonates (50.7 % female) participated in study 2 between 2017 and 2020. Participants reported on their exposure to experiences of discrimination using the Discrimination Stress Scale, and neonatal hair samples were collected shortly after birth (Mediandays=13.0, IQRdays=11-18).

RESULTS

Study 2: Those who had higher discrimination stress during pregnancy had neonates with higher cortisol than those with low discrimination (F(1,70)= 3.78, p = .03), but this relation did not remain significant after controlling for gestational age.

CONCLUSION

Across two cohorts, higher experiences of discrimination were associated with alterations in neonatal hair cortisol. Both higher and lower neonatal hair cortisol are linked to poorer neonatal development, indicating that experiences of discrimination might be a potential source of health disparities in the next generation.

Discrimination and adverse birth outcomes among Latina women: The protective role of social support

OBJECTIVE

Interpersonal discrimination has been associated with adverse birth outcomes among Black populations, but few studies have examined the impact of discrimination among Latinx/Hispanic populations in the United States, especially in conjunction with resources that could be protective. The present study examined (a) if exposure to discrimination is associated with adverse birth outcomes for Latina/Hispanic women and (b) if prenatal social support buffers these links.

METHOD

In two independent prospective studies of Latina/Hispanic women in Southern California (N = 84 and N = 102), the relation between maternal experience of discrimination and birth outcomes (length of gestation and birth weight) was examined. Additionally, social support was tested as a moderator of these relations.

RESULTS

In both Studies 1 and 2, exposures to discrimination predicted adverse birth outcomes. Specifically, lifetime experiences of major discrimination predicted lower birth weight. Additionally, in Study 2, chronic experiences of everyday discrimination were linked to lower birth weight. In Study 1, major discrimination also predicted shorter gestational length. Importantly, in both studies, the presence of prenatal social support buffered associations between discrimination and poorer birth outcomes.

CONCLUSIONS

Findings implicate discrimination as an important risk factor for adverse birth outcomes among women of Latina/Hispanic descent. Further policies, practice, and research on reducing discrimination and enhancing factors that promote resilience such as social support are needed to facilitate healthy births among Latina/Hispanic women, mitigate intergenerational harm of discrimination-related stress, and advance health equity at birth and across the lifespan. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Epigenomic pathways from racism to preterm birth: secondary analysis of the Nulliparous Pregnancy Outcomes Study: monitoring Mothers-to-be (nuMoM2b) cohort study in the USA to examine how DNA methylation mediates the relationship between multilevel racism and preterm birth in black women: a study protocol

INTRODUCTION

Preterm birth is a significant contributor to pregnancy-related morbidity and mortality, particularly affecting black women. Racism is a key driver of perinatal inequities, but mechanisms remain unclear. Epigenomics research offers promise in understanding how environmental exposures, including racism, influence gene expression and adverse pregnancy outcomes. We present our study protocol describing how we will investigate the interactive effects of individual- and structural-level racism on preterm birth within and across black and white women, characterise the blood-based methylome of black pregnant women and identify whether DNA methylation mediates the association between multilevel racism and preterm birth in black women.

METHODS AND ANALYSIS

We will conduct a secondary analysis of data from 6843 participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), a longitudinal, prospective cohort study (2010-2014). Individual-level racism was collected using the Experiences of Discrimination scale. Structural racism measures include racial residential segregation, income and racial polarisation, political participation, judicial treatment, homeownership and employment. These measures will be calculated using geocoded participant addresses and publicly available census data for black and white populations. Epigenome-wide methylation analyses will be conducted on stored DNA for all enrolled black women using the EPIC 2.0 BeadChip. Preterm birth was determined by abstraction from participant electronic health records. We will determine the joint effects of individual and structural racism on preterm birth, characterise DNA methylation profiles associated with preterm birth among black women and explore the mediating role of DNA methylation in the association between multilevel racism and preterm birth.

ETHICS AND DISSEMINATION

Study procedures were approved by the Columbia University Institutional Review Board (#AAAU0215). This study aims to fill critical knowledge gaps regarding the role of racism and epigenomics in preterm birth among black women.

Exposure to Racism and Adverse Pregnancy Outcomes for Black Women: A Systematic Review and Meta-Analysis

Research suggests that stress due to racism may underlie the disproportionately high rates of adverse pregnancy outcomes experienced by Black women in the US. Study objectives: (1) Identify forms of systemic racism affecting pregnancy outcomes and (2) increase understanding about the role of racism in adverse pregnancy outcomes for Black women. A systematic review was conducted to explore the relationship between systemic racism and pregnancy outcomes for Black women. Searches were performed using EBSCO Academic Search Complete, CINAHL Complete, and Consumer Health Complete first between January to April 2021 and subsequently between November 2023 to January 2024. Included studies were observational, written in English, had full-text availability, examined at least one form of systemic racism and pregnancy outcome, and reported results for Black women. A meta-analysis was performed using a random effects model, summary effect estimates were pooled by pregnancy outcome. The I2 statistic was used to measure heterogeneity between studies. A total of 32 studies were included in the review. Significant pooled effects of exposure to systemic racism were observed for preterm birth 0.30 (95% CI 0.12-0.48), small for gestational age 0.31 (95% CI 0.05-0.58), and low birth weight 0.24 (95% CI 0.11-0.37). Among studies that compared results by race, exposure to systemic racism had a significant and rather large effect on preterm birth for Black women (ds = 0.62; 95% CI 0.06-0.41). Exposure to systemic racism has a significant effect on preterm birth, small for gestational age, and low birth weight for Black women. Having knowledge of how racism contributes to stress and poor pregnancy outcomes can help health professionals improve delivery of quality care to Black women. Future research should continue identifying forms of racism positively related to adverse pregnancy outcomes.

A Retrospective Analysis Evaluating the Impact of Neighborhood Deprivation on Birth Weight in Phoenix, Arizona

BACKGROUND

Health inequities begin before birth and are influenced by pregnancy conditions, race/ethnicity, social class, and environment. Research indicates that, in the United States, Black women are significantly more likely to have low-birth-weight babies compared to White women. Interestingly, Hispanic women in the United States do not experience this birth weight inequity. The reasons for this disparity remain unclear. Both Hispanic and Black women face discrimination, and this is often cited as a primary reason for the higher prevalence of low-birth-weight babies among Black women. One type of discrimination that is less examined is neighborhood deprivation.

METHOD

This study systematically examined the impact of various sociodemographic and pregnancy predictors among 9607 women in Phoenix, Arizona. Using multilevel modeling, we analyzed whether neighborhood deprivation (using the Area Deprivation Index) influenced the association between demographic and pregnancy risk and protective factors on birth weight outcomes.

RESULTS

Consistent with prior research, we found that Black and Asian women had lower-birth-weight babies than White women, while Hispanic women did not show a significant difference from non-Hispanic women. Additionally, multilevel modeling suggested that increased neighborhood deprivation tends to exacerbate the impact of some risk factors (e.g., race) and reduce the impact of specific protective factors (e.g., gestational age) on birth weight.

CONCLUSION

These findings suggest that both place and individual factors synergistically influence birth weight outcomes. Moreover, the results underscore the importance of targeting interventions to enhance resources among those who live in the most deprived neighborhoods.

Decoding acculturative stress and psychological distress in Mexican immigrant women: insights from a path mediation analysis

BACKGROUND

This study investigates acculturative stress and its impact on psychological distress among Mexican immigrant women in the United States, with a particular focus on contextual factors shaping these acculturative stress experiences. It also seeks to provide actionable insights to address Mexican immigrant women's mental health needs.

METHODS

Using the data from a total of 257 Mexican immigrant women in the National Latino Asian American Survey (NLAAS), path analysis was conducted to examine the relationships between acculturative stress, psychological distress, and various contextual factors.

RESULTS

Acculturative stress was found to significantly contribute to psychological distress among Mexican immigrant women. Key factors affecting acculturative stress include contentment with the decision to move to the United States, English language proficiency, experiences of racial discrimination, difficulties associated with visiting family abroad, religiosity, and age at immigration. Critical determinants of psychological distress in the studied cohort, according to the results, are familismo values and racial discrimination.

CONCLUSION

The results of this study underscore the need to consider contextual factors in understanding and addressing acculturative stress and psychological distress among Mexican immigrant women. Practical and policy implications include the necessity to develop culturally sensitive interventions, enhance educational opportunities, improve access to mental health services, and implement anti-discrimination policies. By adopting these strategies, mental health professionals and policymakers can foster resilience, wellbeing, and successful integration of Mexican immigrant women in the U.S. society.

Racial Discrimination, Social Support, and Psychological Distress Among Black Pregnant Women

BACKGROUND

Black pregnant women who experience racial discrimination are at an increased risk of psychological distress. Studies have not adequately addressed if social support may moderate the association between experiences of racial discrimination and psychological distress among Black pregnant women.

OBJECTIVE

We sought to examine the moderating effect of social support on the association between experiences of racial discrimination and psychological distress among Black pregnant women.

METHODS

We report findings based on cross-sectional data collected from 599 Black pregnant women enrolled in a prospective cohort study prior to the COVID-19 pandemic. Women completed questionnaires about experiences of racial discrimination (Experiences of Discrimination), social support (MOS Social Support Survey), and psychological distress (Psychological General Wellbeing Index).

RESULTS

Women had an average age of 26 ± 5 years and gestational age at data collection of 17 ± 6 weeks. Approximately 53% of women reported ever experiencing racial discrimination in at least one situation, and 54% reported psychological distress. After adjustment for covariates, racial discrimination was associated with a 2.2-fold increase in psychological distress (odds ratio [OR] = 2.24; 95% confidence interval [CI] 1.35-3.70; P = .002). Low social support (scores below the median) was associated with a 3.8-fold higher likelihood of psychological distress (OR = 3.84, 95% CI 2.27-6.48, P < .001). Social support did not moderate the association of lifetime experiences of racial discrimination with psychological distress.

CONCLUSIONS

Findings of the study contribute to evidence that lifetime experiences of racial discrimination and low levels of social support relate to psychological distress among Black pregnant women.

Discrimination and perinatal depressive symptoms: The protective role of social support and resilience

BACKGROUND

Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms.

METHODS

Pregnant people (N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum.

RESULTS

The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p ≤0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time.

LIMITATIONS

The study relied on self-reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability.

CONCLUSIONS

Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period.

Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders

BACKGROUND

Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.

OBJECTIVE

We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.

STUDY DESIGN

We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.

RESULTS

Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P<.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059-1.059], P<.001). We found a significant interaction between maternal race and rurality (P<.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188-1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843-1.252]).

CONCLUSION

We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection between race and other sociodemographic factors, we hope more targeted and meaningful investments can be made in the communities most in need.

The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities

Despite having the same underlying genetic etiology, individuals with the same syndromic form of intellectual developmental disability (IDD) show a large degree of interindividual differences in cognition and IQ. Research indicates that up to 80% of the variation in IQ scores among individuals with syndromic IDDs is attributable to nongenetic effects, including social-environmental factors. In this narrative review, we summarize evidence of the influence that factors related to economic stability (focused on due to its prevalence in existing literature) have on IQ in individuals with syndromic IDDs. We also highlight the pathways through which economic stability is hypothesized to impact cognitive development and drive individual differences in IQ among individuals with syndromic IDDs. We also identify broader social-environmental factors (e.g., social determinants of health) that warrant consideration in future research, but that have not yet been explored in syndromic IDDs. We conclude by making recommendations to address the urgent need for further research into other salient factors associated with heterogeneity in IQ. These recommendations ultimately may shape individual- and community-level interventions and may inform systems-level public policy efforts to promote the cognitive development of and improve the lived experiences of individuals with syndromic IDDs.

Associations between individual and structural level racism and gestational age at birth in the Nulliparous Pregnancy Outcomes Study: Monitoring mothers-to-be

The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous non-Hispanic Black, non-Hispanic White and Hispanic women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n=7,732) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration (ICE) at the Extremes to measure structural racism. After adjustment,we observed a significant individual and structural racism interaction on gestational length (p=0.03). In subgroup analyses, we found that among these with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.07, 95% CI: 0.24, 1.90). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.

The effects of experience of discrimination and acculturation during pregnancy on the developing offspring brain

The experience of ethnic, racial, and structural inequalities is increasingly recognized as detrimental to health, and early studies suggest that its experience in pregnant mothers may affect the developing fetus. We characterized discrimination and acculturation experiences in a predominantly Hispanic sample of pregnant adolescent women and assessed their association with functional connectivity in their neonate's brain. We collected self-report measures of acculturation, discrimination, maternal distress (i.e., perceived stress, childhood trauma, and depressive symptoms), and socioeconomic status in 165 women. Then, we performed a data-driven clustering of acculturation, discrimination, perceived stress, depressive symptoms, trauma, and socioeconomic status variables during pregnancy to determine whether discrimination or acculturation clustered into distinct factors. Discrimination and acculturation styles loaded onto different factors from perceived stress, depressive symptoms, trauma, and socioeconomic status, suggesting that they were distinct from other factors in our sample. We associated these data-driven maternal phenotypes (discrimination and acculturation styles) with measures of resting-state functional MRI connectivity of the infant amygdala (n = 38). Higher maternal report of assimilation was associated with weaker connectivity between their neonate's amygdala and bilateral fusiform gyrus. Maternal experience of discrimination was associated with weaker connectivity between the amygdala and prefrontal cortex and stronger connectivity between the amygdala and fusiform of their neonate. Cautiously, the results may suggest a similarity to self-contained studies with adults, noting that the experience of discrimination and acculturation may influence amygdala circuitry across generations. Further prospective studies are essential that consider a more diverse population of minoritized individuals and with a comprehensive assessment of ethnic, racial, and structural factors.

Everyday discrimination for American Indian tribal college students enrolled in the Internet All Nations Breath of Life program

OBJECTIVE

Identify factors associated with perceived discrimination, including depression, body image satisfaction, body mass index (BMI), social support, stress, and self-reported social status.

PARTICIPANTS

A total of 249 American Indian tribal college students.

METHODS

Students were recruited for an Internet-based smoking cessation program. A total of 249 students answered the Everyday Discrimination Scale questions to assess perceived discrimination. We conducted bivariate analyses to determine potential significant associations between perceived discrimination and health outcomes at baseline.

RESULTS

We found 63% of the sample reported racial discrimination. Among those who reported moderate/severe depression, 87% reported discrimination. Among those who were not satisfied with their body image, 70% reported racial discrimination.

CONCLUSION

Reports of racial discrimination are highly prevalent among our participants. We found reports of discrimination are significantly associated with depression and dissatisfaction with body image. Our study highlights a high priority population that perceives racial discrimination, potentially increasing their risk for adverse health outcomes.

Maternal grandmothers buffer the effects of ethnic discrimination among pregnant Latina mothers

Ethnic discrimination during pregnancy is linked to maternal psychological distress, adverse birth outcomes and increased offspring morbidity and mortality. An evolutionary perspective reframes offspring health issues as a risk to maternal fitness. We argue that kin may be evolutionarily motivated to buffer psychosocial stressors for the mother during pregnancy. Previously, we found that the relationship of a pregnant woman with her own mother (fetus' maternal grandmother) had a positive association on maternal prenatal psychology, above and beyond her relationship with her fetus' father. Here, we ask if grandmothers buffer mothers' prenatal psychological distress from ethnic discrimination. Using self-report data collected from 216 pregnant Latina women living in Southern California, we found discrimination to be significantly, positively associated with depression, anxiety, and stress in linear regression models. Maternal grandmother communication attenuated the association of discrimination and all three psychological distress measures, adjusting for the mother's relationship with the father. Maternal grandmother emotional support similarly significantly moderated the relationship of discrimination with depression and anxiety. We did not observe any significant interactions for paternal grandmother relationships. Geographic proximity was not a significant stress buffer. Results suggest the important role maternal grandmothers play in perinatal mental health, and that these benefits exist uncoupled from geographic proximity.

Decomposition Analysis of Antenatal Care Utilization Inequities in Kembata Tembaro Zone, Southern Ethiopia

Background

Health equity has emerged as a global issue in the post-2015 Sustainable Development Goals, and Ethiopia is no exception. Despite positive improvements, inequities in maternal health service utilization among demographic groups continue to be one of Ethiopia's significant challenges in decreasing maternal mortality. This study focuses on antenatal care service discrimination among a local poor group known as the "golden hands" community in Ethiopia's Kembata Tembaro zone. The subgroup community consists of outcast artesian groups known as "golden hands," formerly known as "Fuga," who face discrimination in all aspects of life owing to their living conditions and ethnic background.

Methods

A community-based comparative cross-sectional study was conducted in Ethiopia's Kembata Tembaro, zone in the Southern Nations, Nationalities, and Peoples' Region (SNNPR), from January to February 2022. The study focused on two groups, "golden hands" and "non-golden hands," consisting of women aged 15-49 years. Using stratified and multistage cluster sampling, 1,210 participants were selected, with 440 from golden hand communities and 770 from non-golden hand communities. Data was collected through translated questionnaires, and data quality was rigorously monitored. The concentration curve and index, as well as logistic-based decomposition analysis, were used to examine inequality. The statistical significance threshold was set at p < 0.05 with a 95% confidence interval.

Result

This study comprised 1,210 eligible participants, 440 of whom were golden hand community members. Discrimination accounted for 60.23% of the decreased antenatal care (ANC) service use by the golden hand community. Age, urban residence, and wealth index were the most important independent factors with statistically significant contributions to changes owing to differences in effects (discriminated difference).

Conclusion

Since ANC service discrimination is prevalent, the government and nongovernmental organizations should take steps to ensure that marginalized groups in society, such as golden hand women, the poor, the uneducated, and rural people, have equal access to service utilization opportunities.

Health Experiences of African American Mothers, Wellness in the Postpartum Period and Beyond (HEAL): A Qualitative Study Applying a Critical Race Feminist Theoretical Framework

The objective of this study is to explore the cultural, social, and historical factors that affect postpartum primary care utilization among Black women with cardiometabolic risk factors and to identify the needs, barriers, and facilitators that are associated with it. We conducted in-depth interviews of 18 Black women with one or more cardiometabolic complications (pre-pregnancy chronic hypertension, diabetes, obesity, preeclampsia, or gestational diabetes) within one year of delivery. We recruited women from three early home-visiting programs in Baltimore, Maryland, between May 2020 and June 2021. We used Critical Race Feminism theory and a behavioral model for healthcare utilization as an analytical lens to develop a codebook and code interview transcripts. We identified and summarized emergent patterns and themes using textual and thematic analysis. We categorized our findings into six main themes: (1) The enduring influence of structural racism, (2) personally mediated racism in healthcare and beyond, (3) sociocultural beliefs about preventative healthcare, (4) barriers to postpartum care transitions, such as education and multidisciplinary communication, (5) facilitators of postpartum care transitions, such as patient-provider relationships and continuity of care, and (6) postpartum health and healthcare needs, such as mental health and social support. Critical race feminism provides a valuable lens for exploring drivers of postpartum primary care utilization while considering the intersectional experiences of Black women.

Microbial modulation via cross-fostering prevents the effects of pervasive environmental stressors on microglia and social behavior, but not the dopamine system

Environmental toxicant exposure, including air pollution, is increasing worldwide. However, toxicant exposures are not equitably distributed. Rather, low-income and minority communities bear the greatest burden, along with higher levels of psychosocial stress. Both air pollution and maternal stress during pregnancy have been linked to neurodevelopmental disorders such as autism, but biological mechanisms and targets for therapeutic intervention remain poorly understood. We demonstrate that combined prenatal exposure to air pollution (diesel exhaust particles, DEP) and maternal stress (MS) in mice induces social behavior deficits only in male offspring, in line with the male bias in autism. These behavioral deficits are accompanied by changes in microglial morphology and gene expression as well as decreased dopamine receptor expression and dopaminergic fiber input in the nucleus accumbens (NAc). Importantly, the gut-brain axis has been implicated in ASD, and both microglia and the dopamine system are sensitive to the composition of the gut microbiome. In line with this, we find that the composition of the gut microbiome and the structure of the intestinal epithelium are significantly shifted in DEP/MS-exposed males. Excitingly, both the DEP/MS-induced social deficits and microglial alterations in males are prevented by shifting the gut microbiome at birth via a cross-fostering procedure. However, while social deficits in DEP/MS males can be reversed by chemogenetic activation of dopamine neurons in the ventral tegmental area, modulation of the gut microbiome does not impact dopamine endpoints. These findings demonstrate male-specific changes in the gut-brain axis following DEP/MS and suggest that the gut microbiome is an important modulator of both social behavior and microglia.

Intergenerational risk and resilience pathways from discrimination and acculturative stress to infant mental health

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers' exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related to more infant negative emotionality at approximately 12 months old (M = 12.6, SD = .75). In contrast, maternal report of parenting self-efficacy when infants were 6 months old was related to lower levels of infant negative emotionality. Further, higher levels of parenting self-efficacy mitigated the relation between acculturative stress and negative emotionality. Preconception and prenatal exposure to sociocultural stress may be a risk factor for poor offspring mental health. Maternal and child health researchers, policymakers, and practitioners should prioritize further understanding these relations, reducing exposure to sociocultural stressors, and promoting resilience.

Discrimination and Depressive Symptoms Among Mexican American Women: Exploring Multilevel Sociocultural Moderators

Relative to empirical studies on risk factors, less research has focused on culturally based protective factors that reduce the impact of discrimination on mental health. The current prospective study evaluated two potential moderators of the effect of discrimination on depressive symptoms among Mexican American women: individually held familism values and neighborhood cultural cohesion. Mexican-origin women in the United States (N = 322; mean age = 27.8 years; 86% born in Mexico) reported on frequency of discrimination, depressive symptoms, familism, and neighborhood cultural cohesion. Independent models evaluated familism and neighborhood cultural cohesion as moderators of the effect of discrimination on subsequent depressive symptoms. More frequent discrimination predicted higher subsequent depressive symptoms. High familism buffered the harmful effect of discrimination on depressive symptoms, such that more frequent discrimination was associated with higher subsequent depressive symptoms only for women who reported average and low familism. Neighborhood cultural cohesion did not buffer the effect of discrimination on depressive symptoms.

County-level jail incarceration, community economic distress, rurality, and preterm birth among women in the US South

Introduction

The USA has higher rates of preterm birth and incarceration than any other developed nation, with rates of both being highest in Southern states and among Black Americans, potentially due to rurality and socioeconomic factors. To test our hypothesis that prior-year county-level rates of jail admission, economic distress, and rurality were positively associated with premature birth rates in the county of delivery in 2019 and that the strength of these associations is greater for Black women than for White or Hispanic women, we merged five datasets to perform multivariable analysis of data from 766 counties across 12 Southern/rural states.

Methods

We used multivariable linear regression to model the percentage of babies born premature, stratified by Black (Model 1), Hispanic (Model 2), and White (Model 3) mothers. Each model included all three independent variables of interest measured using data from the Vera Institute, Distressed Communities Index, and Index of Relative Rurality.

Results

In fully fitted stratified models, economic distress was positively associated with premature births among Black (F = 33.81, p < 0.0001) and White (F = 26.50, p < 0.0001) mothers. Rurality was associated with premature births among White mothers (F = 20.02, p < 0.0001). Jail admission rate was not associated with premature births among any racial group, and none of the study variables were associated with premature births among Hispanic mothers.

Conclusions

Understanding the connections between preterm birth and enduring structural inequities is a necessary scientific endeavor to advance to later translational stages in health-disparities research.

Sexual Orientation-Related Nondiscrimination Laws and Maternal Hypertension Among Black and White U.S. Women

Background: Black women and sexual minority women are more likely to report adverse maternal health. Little research has investigated maternal health disparities at the intersection of race/ethnicity and sexual orientation or the mechanisms that contribute to these disparities. Materials and Methods: We analyzed data from the National Longitudinal Study of Adolescent to Adult Health. Our sample was restricted to Black and White women who had at least one live birth and were followed-up in Wave V of the data (n = 3,396). We used multivariable logistic regression to analyze the associations between race, sexual orientation identity, and a four-item state-level index of sexual orientation-related nondiscrimination laws. Results: We found that higher numbers of state-level sexual orientation-related nondiscrimination laws were associated with lower risk of maternal hypertension among U.S. women overall (odds ratio [OR] = 0.82, 95% confidence interval [CI] 0.73-0.93), and Black women had a higher risk of maternal hypertension relative to White women (OR = 1.32, 95% CI 1.00-1.79). Interactions between race, sexual orientation identity, and sexual orientation-related policies show that, regardless of sexual orientation identity, sexual orientation-related nondiscrimination laws were associated with a lower risk of maternal hypertension among White mothers (OR = 0.80, 95% CI 0.70-0.92). However, among Black women, these laws were associated with a lower risk of maternal hypertension among lesbian and bisexual women (OR = 0.18, 95% CI 0.05-0.68) only. Conclusions: Laws that prevent discrimination related to sexual orientation in various societal domains may play an important role in improving maternal health outcomes among White women in general and Black lesbian and bisexual women in particular.

Double Impact: A Dyadic Discrimination Model for Poor, Minority, and Pregnant Couples

Frequent daily discrimination compounds the negative health impacts of those with multiple marginalized identities, including pregnant mothers and their children. We used a dyadic, moderated, mediated model of 296 young, expectant, poor, urban, primarily minority couples. In this study, we explored if a multiple pathway discrimination model explained the relationship between multiple marginalized identities and health (depression and stress). We also examined if a mediated (discrimination moderated by gender) model, within a minority-stress and intersectional framework explained the relationship with depression and stress for couples. We observed that frequent daily discrimination was associated with negative health outcomes (depression and stress). Women reported significantly more depression than men. Frequent daily discrimination mediated the relationship between multiple marginalized identities and depression and stress and having a partner with multiple marginations increased one's personal depression and stress. Our observations suggest that discrimination's impact on health is experienced during pregnancy and the more marginalized identities one carries, the more impact it may have. Further, having a partner with multiple marginalized identities also impacts the depression and stress reported by women. Inventions to address depression and stress outcomes may be strengthened by considering multiple marginalized identities and include couples.

Discrimination is associated with poor sleep quality in pregnant Black American women

BACKGROUND

Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes.

METHODS

We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status.

RESULTS

Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships.

CONCLUSIONS

Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.

Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox

In the United States, African American or non-Hispanic Black infants experienced worst birth outcomes whereas Hispanic and Asian infants have intermediate or similar outcomes compared with non-Hispanic white infants. The findings of better birth outcomes for Hispanic women have been coined the "Hispanic Paradox" given their low education, income, and access to care. New York City (NYC) has a great racial/ethnic diversity with implications for neighborhood racial/ethnic composition on birth outcomes by protecting women from psychosocial stress via social support that may buffer against racial/ethnic discrimination and/or racism. Data from 2012 to 2018 were used to examine the association of NYC women's race/ethnicity and neighborhood racial/ethnic minority composition with adverse birth outcomes (low birthweight [LBW], small for gestational age [SGA], preterm birth and infant mortality); and whether the association between mother's race/ethnicity and each birth outcome differed by neighborhood racial/ethnic composition. Multilevel logistic regression was used to control for the clustering of outcomes within neighborhoods. Black, Asian, and American Indian women have poorer birth outcomes than white women. Infants of Mexican American, Central American, and South American women were less likely to be of LBW whereas the opposite was true for infants of Cuban and other Hispanic women compared with infants of white women. When compared with white women, Mexican American, and South American women were less likely to have an SGA infant whereas Puerto Rican and other Hispanic women were more likely to have an SGA infant. All Hispanic women were more likely to have a preterm birth than white women whereas for infant mortality, greater odds of dying were observed for infants of Puerto Rican, Dominican, and other Hispanic women. Higher neighborhood racial/ethnic minority composition was associated with greater odds of having an adverse outcome. Finally, we observed heterogeneity of the associations between mother's race/ethnicity and birth outcomes by neighborhood racial/ethnic minority composition.

Maternal gender discrimination and child emotional and behavioural problems: A population-based, longitudinal cohort study in the Czech Republic

BACKGROUND

Gender discrimination may be a novel mechanism through which gender inequality negatively affects the health of women and girls. We investigated whether children's mental health varied with maternal exposure to perceived gender discrimination.

METHODS

Complete longitudinal data was available on 2,567 mother-child dyads who were enrolled between March 1, 1991 and June 30, 1992 in the European Longitudinal Cohort Study of Pregnancy and Childhood-Czech cohort and were surveyed at multiple time points between pregnancy and child age up to 15 years. The Strengths and Difficulties Questionnaire (SDQ) was administered at child age 7, 11, and 15 years to assess child emotional/behavioural difficulties. Perceived gender discrimination was self-reported in mid-pregnancy and child age 7 and 11 years. Multilevel mixed-effects linear regression of SDQ scores were estimated. Mediation was tested using structural equation models.

FINDINGS

Perceived gender discrimination, reported by 11.2% of mothers in mid-pregnancy, was related to increased emotional/behavioural difficulties among children in bivariate analysis (slope = 0.24 [95% confidence interval (CI): 0.15, 0.32], p<0.0001) and in the fully adjusted model (slope = 0.18 [95% CI: 0.09, 0.27], p<0.0001). Increased difficulties were evident among children of mothers with more depressive symptoms (slope = 0.04 [95% CI: 0.03, 0.05], p<0.0001), boys (slope = 0.26 [95% CI: 0.19, 0.34], p<0.0001), first children (slope = 0.16 [95% CI: 0.09, 0.23], p<0.0001), and families under financial hardship (slope = 0.09 [95% CI: 0.04, 0.14], p<0.0001). Effects were attenuated for married mothers (slope-0.12 [95% CI: -0.22, -0.01], p<0.05]. Maternal depressive symptoms and financial hardship mediated about 37% and 13%, respectively, of the total effect of perceived gender discrimination on SDQ scores.

INTERPRETATION

Perceived gender discrimination among child-bearing women in family contexts was associated with more mental health problems among their children and adolescents, extending prior research showing associations with maternal mental health problems. Maternal depressive symptoms and, to a lesser extent, financial hardship both partially mediated the positive relationship between perceived gender discrimination and child emotional/behavioural problems. This should be taken into consideration when measuring the societal burden of gender inequality and gender-based discrimination. Moreover, gender-based discrimination affects more than one gender and more than one generation, extending to boys in the household even moreso than girls, highlighting that gender discrimination is everyone's issue. Further research is required on the intergenerational mechanisms whereby gender discrimination may lead to maternal and child mental health consequences.

FUNDING

Bill and Melinda Gates Foundation; Ministry of Education, Youth and Sports, Czech Republic and European Structural and Investment Funds.

Vicarious structural racism and infant health disparities in Michigan: The Flint Water Crisis

Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: -0.09, -0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: -0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.

The immigrant birthweight paradox in an urban cohort: Role of immigrant enclaves and ambient air pollution

BACKGROUND

Foreign-born Black and Latina women on average have higher birthweight infants than their US-born counterparts, despite generally worse socioeconomic indicators and prenatal care access, i.e., "immigrant birthweight paradox" (IBP). Residence in immigrant enclaves and associated social-cultural and economic benefits may be drivers of IBP. Yet, enclaves have been found to have higher air pollution, a risk factor for lower birthweight.

OBJECTIVE

We investigated the association of immigrant enclaves and children's birthweight accounting for prenatal ambient air pollution exposure.

METHODS

In the Boston-based Children's HealthWatch cohort of mother-child dyads, we obtained birthweight-for-gestational-age z-scores (BWGAZ) for US-born births, 2006-2015. We developed an immigrant enclave score based on census-tract percentages of foreign-born, non-citizen, and linguistically-isolated households statewide. We estimated trimester-specific PM_2.5 concentrations and proximity to major roads based residential address at birth. We fit multivariable linear regressions of BWGAZ and examined effect modification by maternal nativity. Analyses were restricted to nonsmoking women and term births.

RESULTS

Foreign-born women had children with 0.176 (95% CI: 0.092, 0.261) higher BWGAZ than US-born women, demonstrating the IBP in our cohort. Immigrant enclave score was not associated with BWGAZ, even after adjusting for air pollution exposures. However, this association was significantly modified by maternal nativity (p_interaction = 0.014), in which immigrant enclave score was positively associated with BWGAZ for only foreign-born women (0.090, 95% CI: 0.007, 0.172). Proximity to major roads was negatively associated with BWGAZ (-0.018 per 10 m, 95% CI: -0.032, -0.003) and positively correlated with immigrant enclave scores. Trimester-specific PM_2.5 concentrations were not associated with BWGAZ.

SIGNIFICANCE

Residence in immigrant enclaves was associated with higher birthweight children for foreign-born women, supporting the role of immigrant enclaves in the IBP. Future research of the IBP should account for immigrant enclaves and assess their spatial correlation with potential environmental risk factors and protective resources.

The associations among racial discrimination, pubertal timing, neighborhoods, and mental health among U.S. Mexican boys

The present study addressed gaps in puberty and weathering research by examining the relation between peer racial discrimination, pubertal timing, internalizing and externalizing symptoms, and neighborhood context among a longitudinal sample of U.S. Mexican boys. Using three waves of data (N = 383; mean ages: 10.3-15.8 years), we examined the weathering hypothesis: Whether peer racial discrimination experiences in late childhood predicted earlier pubertal timing in adolescence and subsequent mental health problems. We also examined whether variability in youths' neighborhood contexts qualified these associations. Consistent with the weathering hypothesis, exposure to peer racial discrimination in 5th grade, predicated earlier pubertal timing in the 7th grade, which, in turn, predicted increases in internalizing symptoms in the 10th grade. However, this pattern only applied to boys residing in neighborhoods with higher levels of Latinx concentration in 5th grade. Additionally, early timing in the 7th grade predicted increases in externalizing symptoms, but this association was significant only when boys lived in neighborhoods that were lower on Latinx concentration. There was evidence of weathering in context with specific implications for internalizing symptoms, and that neighborhood Latinx concentration was both inhibiting and promoting at unique places in the hypothesized model. The findings advance existing understandings of weathering patterns and individual variation in pubertal timing among U.S. Mexican boys. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family Educational Attainment and Racial Disparities in Low Birth Weight

OBJECTIVES

To evaluate the effect of grandmother and mother educational attainment on low birth weight (LBW) in children and grandchildren.

METHODS

The National Longitudinal Study of Adolescent to Adult Health is a multigenerational study that collected survey data from 1994 to 2018. Using this database, we constructed a cohort of 2867 non-Hispanic Black (NHB) and non-Hispanic White (NHW) grandmother-mother-grandchild triads to evaluate how education affects the likelihood of having LBW children and grandchildren, while adjusting for socioeconomic and maternal health factors using multivariable logistic regression.

RESULTS

Similar to previous studies, NHB women were more likely to have LBW descendants compared with NHW women in unadjusted and adjusted analyses. The prevalence of LBW descendants was lower in women with college education, regardless of race. Irrespective of race, mother and grandmother college education was associated with decreased odds of LBW children and grandchildren after adjusting for individual variables. When mother and grandmother education were examined together, and after adjusting for all individual, community, and health variables together, mother college education remained associated with lower odds of LBW (adjusted odds ratio, 0.58; 95% confidence interval, 0.44-0.77). There were no statistically significant differences in these effects between NHW and NHB populations.

CONCLUSIONS

Educational attainment in mothers is associated with decreased odds of LBW descendants after adjusting for multiple individual, community, and health covariates, regardless of race. Targeting improvements in education may ameliorate adverse pregnancy outcomes that disproportionately affect minority communities and cause significant lifelong consequences.

Intergenerational Effects of Discrimination on Black American Children's Sleep Health

Greater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women's lifetime exposure to racial/ethnic discrimination and their two-year-old children's sleep health. We also examined women's gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children's sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women's experiences of discrimination and children's sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women's prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women's prenatal mental health and their children's sleep health.

A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development

Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.

Structural Heteropatriarchy and Birth Outcomes in the United States

Emerging evidence links structural sexism and structural discrimination against lesbian, gay, and bisexual (LGB) populations to poor health outcomes, but studies have yet to examine the combined effects of these mutually reinforcing systems of inequality. Therefore, we developed a composite measure of structural heteropatriarchy-which includes state-level LGB policies, family planning policies, and indicators of structural sexism (e.g., women's political and economic position relative to men)-and examined its relationship to birth outcomes using data from Waves I to V of the National Longitudinal Study of Adolescent to Adult Health. Multivariate regression analyses demonstrated that higher levels of heteropatriarchy were associated with an increased risk of preterm birth and decreased birth weight, net of important covariates. There was no association between clinical low birth weight and heteropatriarchy, or interactions between heteropatriarchy and individuals' race, ethnicity or sexual identity, suggesting a negative effect of heteropatriarchy on birth outcomes for all pregnant people. This study demonstrates the importance of considering gender and sexuality as mutually reinforcing systems of oppression that impact population health. Future research should examine the impact of heteropatriarchy on additional health outcomes and in conjunction with other structural inequalities such as racism and transgender oppression.

Which roads lead to depression in Latinas? A network analysis of prenatal depressive symptoms, discrimination, acculturative stress, and low birth weight

Although immigrant mothers from some Latinx subgroups initially achieve healthy birth outcomes despite lower socioeconomic status, this advantage deteriorates across generations in the United States. Interpersonal discrimination and acculturative stress may interact with economic hardship to predict an intergenerational cascade of emotional and biological vulnerabilities, particularly perinatal depression. Network analyses may elucidate not only how and which psychosocial experiences relate to depressive symptoms, but which symptom-to-symptom relationships emerge. This study aims to understand (1) how economic, acculturative, and discrimination stressors relate to prenatal depression and low birth weight and (2) how Latinas may respond to and cope with stressors by exploring symptom-symptom and symptom-experience relationships. A sample of 151 pregnant Latinas (predominantly foreign-born and Mexican and Central American descent) completed the EPDS and psychosocial questionnaires (discrimination, acculturation, acculturative stress, economic hardship) during pregnancy (24-32 weeks). Birth weights were recorded from postpartum medical records. We created network models using the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator to estimate the relationship between variables. Discrimination exposure connected psychosocial stressors to depressive symptoms, particularly worry, crying, sadness, and self-blame. Discrimination also revealed a connection between acculturation and low birth weight. Furthermore, younger age of migration and greater acculturation levels were correlated to greater discrimination stress and low birth weights. Perinatal research in Latinas must account not only for measures of cultural adaptation but recognize how developmental exposures across the life span, including discrimination, may be associated with adverse health trajectories for a mother and her child.

“Police shootings, now that seems to be the main issue” – Black pregnant women’s anticipation of police brutality towards their children

Background

A disproportionate number of people who are killed by police each year are Black. While much attention rightly remains on victims of police brutality, there is a sparse literature on police brutality and perinatal health outcomes. We aimed to explore how Black pregnant women perceive police brutality affects them during pregnancy and might affect their children.

Methods

This qualitative study involved semi-structured interviews among 24 Black pregnant women in New Haven, Connecticut (January 2017 to August 2018). Interview questions explored neighborhood factors, safety, stressors during pregnancy, and anticipated stressors while parenting. Grounded theory informed the analysis.

Results

Participants, regardless of socioeconomic status, shared experiences with police and beliefs about anticipated police brutality, as summarized in the following themes: (1) experiences that lead to police distrust – “If this is the way that mommy’s treated [by police]”; (2) anticipating police brutality – “I’m always expecting that phone call”; (3) stress and fear during pregnancy – “It’s a boy, [I feel] absolutely petrified”; and (4) ‘the talk’ about avoiding police brutality – “How do you get prepared?” Even participants who reported positive experiences with police anticipated brutality towards their children.

Conclusions

Interactions between Black people and police on a personal, familial, community, and societal level influenced how Black pregnant women understand the potential for police brutality towards their children. Anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes. Police brutality must be addressed in all communities to prevent harming the health of birthing people and their children.

State-Level Regulations Regarding the Protection of Sexual Minorities and Birth Outcomes: Results From a Population-Based Cohort Study

OBJECTIVE

We leverage state-level variability in social policies that confer legal protections for sexual minorities (e.g., employment nondiscrimination acts) and examine their association with birth outcomes among sexual minority women.

METHODS

We link measures of structural protections (i.e., social policies) to a prospective, population-based cohort of US adults-the National Longitudinal Study of Adolescent to Adult Health ( n = 7913 total singleton births, n = 274 singleton births to bisexual women, n = 53 singleton births to lesbian women)-which includes measurement of key risk factors for birth outcomes over the life course.

RESULTS

Lesbian, gay, bisexual (LGB) policy protections were associated with better birth outcomes for lesbian women. For example, among lesbian women, the predicted birth weight for infants in states with no policy protections was 3.01 kg (95% confidence interval = 2.71-3.30) but was 3.71 kg (95% confidence interval = 3.46-3.96) in states with three or four policy protections. In negative control analyses, there was no association between LGB policy protections and birth outcomes among the nonstigmatized group (i.e., heterosexual women), providing evidence of specificity. Furthermore, in states with the most LGB policy protections, lesbian women were at lower risk for preterm births and had infants with higher birth weights than heterosexual and bisexual women. These associations remained robust after adjusting for 13 risk factors, including demographics, prior and current indicators of socioeconomic status, preconception and perinatal risk factors, and neighborhood characteristics.

CONCLUSIONS

These results provide novel evidence that sexual orientation-related policy protections, measured at the state level, are associated with a decreased risk for adverse birth outcomes among lesbian women.

Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study

To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.

Perceived Racial Discrimination in the Pregnant African American Population: A Concept Analysis

African American women experience higher lifetime exposure to chronic stressors, such as perceived racial discrimination. Clearly defining perceived racial discrimination in the pregnant African American population has the potential to better explain the phenomenon and how it relates to adverse birth outcomes such as preterm birth. The purpose of this concept analysis is to more clearly define perceived racial discrimination in the pregnant African American population using Rodgers' evolutionary method. Defining the concept of interest has the potential to uncover modifiers that may help close the gap in the Black-White infant mortality rates in the United States.

Racial and ethnic disparities in birth Outcomes: A decomposition analysis of contributing factors

This study seeks to quantify and rank the contribution of selected factors to the observed racial/ethnic disparities in low-birth-weight births (LBWBs) and preterm births (PTBs). Based on vital statistics data on births to primiparous women and characteristics of mothers in the State of Nebraska during the period of 2005 to 2014 (n = 93,375), unadjusted and adjusted odds ratios were estimated to examine the association between selected variables and the odds of having LBWBs or PTBs. Fairlie decomposition analysis was performed to quantify the contribution of each selected factor to racial/ethnic differences in LBWB and PTB rates. The prevalence of PTBs was 9.1% among non-Hispanic White (NHW) women, as compared to 12.8% among non-Hispanic Black (NHB) women and 10.6% among Hispanic women. The corresponding prevalence of LBWBs in the three groups were 5.9%, 11.9%, and 7.2%, respectively. The higher educational attainment among NHW women, relative to NHB women accounted for 10% of the observed difference in LBWB rate between the two groups. Health insurance coverage was the second most important factor accounting for the observed disparities in birth outcomes. Addressing socioeconomic disadvantages in NHB and Hispanic women would be important for them to narrow their gaps with NHW women in LBWB and PTB prevalence. More research is needed to identify key factors leading to the disparities in birth outcomes between NHW and NHB women.

Whither weathering? The variable significance of age in Black-White low birth weight disparities

This paper uses birth certificate data to provide novel estimates of the age-specific risk of a low birth weight birth (LBW, an infant born weighting <2500 g) for U.S.-born non-Hispanic Black and White mothers, and finds that patterns vary markedly over space and time. Notably, risk of an LBW birth for Black mothers increased much more steeply with age in 1991-94 than in 2014-17. This decline in LBW risks among older Black mothers led to a decline in the Black-White LBW gap of more than half a percentage point. Both patterns and changes were regional; while age gradients on the Black-White LBW gap were lowest in the South in 1991-94, by 2014-17 they had increased in the South and declined in the rest of the country. These descriptive data allow a new examination of hypotheses regarding the causes of age-specific racial LBW gaps. Research has found that racial disparities in a number of health outcomes, including LBW, increase with age, leading some to speculate that this increase is due to the cumulative effects of exposure to disadvantage. The large degree of variability in Black-White LBW disparities suggests that age-specific causes may also play a role. A series of counterfactual trend analyses explore the roles of two specific mechanisms, smoking and hypertension, and compares these to a more fundamental indicator of socioeconomic status: education.

Examining the Role of Psychosocial Influences on Black Maternal Health During the COVID-19 Pandemic

Introduction

Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities.

Methods

We examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people.

Results

Even prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women.

Conclusion

We recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene.

Examining the Influence of Racial Discrimination on Adverse Birth Outcomes: An Analysis of the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS), 2016-2018

OBJECTIVES

In Virginia, Black women experience higher rates of adverse birth and labor outcomes that may not be explained solely by risky behaviors or social standing. Previous studies have found an association between racial discrimination and adverse birth outcomes; however, their findings may be underpowered due to small sample sizes. The purpose of this study was to examine the relationship between racial discrimination and poor birth outcomes.

METHODS

VA PRAMS (2016-2018) was used for this secondary data analysis of mothers age 15-44. The exposure was measured using two VA PRAMS questions on racial discrimination and information on the outcomes were extracted from birth certificate data. Simple logistic regression was used obtain an association between experiencing racial discrimination and adverse birth outcomes (i.e. preterm birth, low birth weight, and small for gestational age) and to identify risk factors for experiencing racial discrimination. Multivariate logistic regressions were performed after controlling for other covariates.

RESULTS

Virginia women (N = 2634) who experienced racial discrimination had statistically significant increased odds of having a low birth weight infant (OR 2.27; 95% CI 1.18, 4.38); however, when stratified by race, only non-Hispanic Black (n = 540) women had statistically significant increased odds of preterm birth and low birth weight (PTB OR 7.18; 95% CI 2.28, 22.65; LBW OR 3.56; 95% CI 1.28, 9.91).

CONCLUSIONS

Non-Hispanic Black women in Virginia who experience racial discrimination are more likely to have low birth weight and preterm births. Efforts to effectively reduce adverse birth outcomes and eliminate racial inequities must consider upstream, holistic approaches beyond the biomedical model.

Sexual Identity and Birth Outcomes: A Focus on the Moderating Role of Race-ethnicity

Race-ethnic disparities in birth outcomes are well established, and new research suggests that there may also be important sexual identity disparities in birth weight and preterm birth. This study uses the National Longitudinal Study of Adolescent to Adult Health and is the first to examine disparities in birth outcomes at the intersection of race-ethnicity and sexual identity. We use ordinary least sqaures and logistic regression models with live births (n = 10,318) as the unit of analysis clustered on mother ID (n = 5,105), allowing us to adjust for preconception and pregnancy-specific perinatal risk factors as well as neighborhood characteristics. Results show a striking reversal in the effect of lesbian or bisexual identity on birth outcomes across race-ethnicities: For white women, a bisexual or lesbian identity is associated with better birth outcomes than their white heterosexual counterparts, but for Black and Latina women, it is associated with worse birth outcomes than their heterosexual peers.

Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset

BACKGROUND

High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women.

PURPOSE

To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes.

METHODS

Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April-May 2020. This report focuses on the 1,367 participants who gave birth prior to July-August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors.

RESULTS

After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm.

CONCLUSION

Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.

Biopsychosocial correlates of psychological distress in Latina mothers

BACKGROUND

Few studies have explored the relationship between psychological, psychosocial and biological factors among Latinas. An integrated understanding of how these factors associate with psychological distress is necessary for the development of culturally relevant screening tools and interventions. The study aim was to examine the relationships among (a) psychological distress symptoms, (b) psychosocial factors (discrimination, acculturation, acculturative stress, economic hardship), and (c) biological (DNA methylation of stress-related genes) factors among Latinas during pregnancy and postpartum period.

METHODS

A sample of 150 pregnant Latinas completed the Inventory of Depression and Anxiety Symptoms II (IDAS-II), psychosocial questionnaires (discrimination, acculturation, acculturative stress, economic hardship) before (24-32 weeks) and after gestation (4-6 weeks postpartum). Blood samples were collected between 24-32 weeks gestation. Correlations were determined between psychosocial and biological measures and psychological distress measures. Multivariable linear regression models were conducted to assess the relationships between IDAS and stressors.

RESULTS

Several correlations among psychosocial measures,DNA methylation factors and IDAS-II variables were identified. Among the psychosocial measures, everyday discrimination was the most strongly and consistently associated with IDAS-II. DNA methylation of NR3C1 affects the associations between psychological and psychosocial distress.

LIMITATIONS

We only assessed DNA methylation during pregnancy and focused on four HPA-related genes. Longitudinal assessment of DNA methylation and genome-wide analysis can provide a better picture of the role of methylation in psychological distress.

CONCLUSIONS

This work may assist clinicians and policy makers in effectively recognizing and preventing maternal mental health disparities based on discrimination and other psychosocial stressors in at-risk groups.

The Association between Maternal Experiences of Interpersonal Discrimination and Adverse Birth Outcomes: A Systematic Review of the Evidence

In the present systematic review, we argue that maternal experiences of interpersonal discrimination at least partially account for the disproportionate rates of adverse birth outcomes in minority populations. Since the 1990s, research in this area has slowly, but steadily increased, shedding more light on the insidious nature of interpersonal discrimination and its toxic health effects. With the aim of bringing this topic to the fore in academic as well as clinical settings, this paper provides a state-of-the-art review of the empirical knowledge on the relationship between maternal experiences of discrimination and birth outcomes. Of 5901 articles retained in the literature search, 28 met the predefined inclusion criteria. Accounting for a range of health and behavioral factors, the vast majority of these studies support the notion that maternal experiences of interpersonal discrimination predict a range of adverse birth outcomes, including preterm birth, low birth weight, and various physiological markers of stress (allostatic load) in both mother and child pre- and postpartum. Several moderators and mediators of this relationship were also identified. These related primarily to the type (first-hand and vicarious), timing (childhood, adolescence, and adulthood), frequency, and pervasiveness of discrimination experienced, as well as to maternal mental health and coping. More research into these factors, however, is required to definitively determine their significance. We discuss these findings as they relate to the general health repercussions of interpersonal discrimination, as well as in terms of applied prenatal care and interventions. Ultimately, we argue that assessing maternal experiences of interpersonal discrimination in prenatal care may represent a considerable asset for mitigating existing majority-minority disparities in adverse birth outcomes.

A prenatal programming perspective on the intergenerational transmission of maternal adverse childhood experiences to offspring health problems

Decades of research indicate that individuals exposed to childhood adversity are at risk for poor physical and mental health across their life span. More recently, intergenerational transmission of trauma and prenatal programming frameworks suggest an even longer reach for adverse childhood experiences (ACEs), with consequences that extend to subsequent generations. Beyond the individual-level consequences typically observed by empirical studies of ACEs, mothers' experiences of early adversity may also compromise the maternal-child dyadic relationship. We propose a conceptual model whereby mothers' ACEs impact maternal-infant dyadic functioning and later biobehavioral health outcomes through heightened perinatal psychosocial risk. We provide support for the proposed paths and mechanistic processes in our model with data drawn from Las Madres Nuevas, a longitudinal study of low-income Mexican-origin families who participated in a series of home and laboratory visits from the prenatal period through early childhood. Higher ACEs exposure among Las Madres Nuevas participants was associated with numerous perinatal psychosocial risk factors, which predicted poorer mother-infant dyadic functioning. Compromised dyadic functioning during infancy was associated with later maternal mental health and child behavior problems. We conclude with discussion of prevention and treatment strategies that can buffer against proposed risk pathways, including perinatal assessment of maternal ACEs and psychosocial risk, perinatal treatment of maternal distress, and mother-infant therapy in the postpartum period. It is our hope that the proposed conceptual model will serve as a guide for future research to examine the lasting consequences of childhood adversities within and across generations among high-risk populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice

INTRODUCTION

Black women are more likely to undergo surgery for uterine fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking fibroid treatment. We aimed to identify factors that shape Black women's fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences, and compare experiences across age and socioeconomic status.

METHODS

We conducted semistructured interviews with 37 Black women undergoing surgery for fibroid management. We used a thematic analysis to code transcripts and identify themes.

RESULTS

Participants were predominately single, college educated, and insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Knowledge and perceptions of fibroids were also influenced by community norms and differed by socioeconomic status; women of higher socioeconomic status had greater fibroid awareness than women of lower socioeconomic status. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. Although several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians.

CONCLUSIONS

Fibroid management decisions were influenced not only by interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver intersectional gynecologic care that centers the voices of Black women seeking fibroid treatment.