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Updated: Sep 2, 2025

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Published on: January 12, 2018
Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis
Kim Robin van Daalen1, Jeenan Kaiser2, Samuel Kebede3
1Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK krv22@cam.ac.uk.
Racial discrimination is linked to adverse pregnancy outcomes like preterm birth. This systematic review confirms this association, highlighting the need for further research into underlying mechanisms and diverse populations.
Area of Science:
- Public Health
- Reproductive Health
- Social Determinants of Health
Background:
- Racial discrimination is a known contributor to health disparities.
- Existing research suggests a link between racial discrimination and adverse pregnancy outcomes.
- This study aims to systematically review and meta-analyze evidence on this association.
Purpose of the Study:
- To assess the association between self-reported racial discrimination and adverse pregnancy outcomes.
- To quantify the risk of adverse pregnancy outcomes associated with racial discrimination through meta-analysis.
Main Methods:
- Systematic review and meta-analysis of 24 articles retrieved from eight databases.
- Quality assessment using Newcastle-Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE).
- Random effects meta-analyses performed for preterm birth and small for gestational age.
Main Results:
- Significant positive associations were reported between racial discrimination and adverse pregnancy events.
- Pooled odds ratio (OR) for preterm birth was 1.40 (95% CI 1.17 to 1.68).
- Excluding low-quality studies, the preterm birth OR was 1.31 (95% CI 1.08 to 1.59), indicating a robust association.
Conclusions:
- Racial discrimination adversely impacts pregnancy outcomes, including preterm birth.
- The findings align with broader literature on racial discrimination as a health risk factor.
- Higher quality evidence from diverse cohorts is needed to explore mechanisms and mediating factors.
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