Comparing severe maternal morbidity and neonatal outcomes between Somali and non-Somali black birthing cohorts

Black birthing individuals experience worse perinatal outcomes compared to White counterparts, yet within-group differences among Black populations remain understudied. The U.S. Black population is heterogeneous, encompassing long-established U.S.-born communities and immigrants from across the African diaspora, whose health profiles may differ. Somali immigrants represent the largest African-born population in many U.S. communities and face documented challenges including cultural adaptation and language barriers. However, severe maternal morbidity (SMM) has not been specifically studied in this population.

To compare severe maternal morbidity and neonatal birth outcomes between Somali and non-Somali Black birthing individuals.

This was a retrospective cohort study from 2016 to 2024, in which Somali and non-Somali Black individuals were identified within an academic-community health system. Somali individuals were identified using self-reported Black/African race combined with documented primary language (Somali) and/or country of origin (Somalia); individuals meeting either language or country criterion with Black/African race were classified as Somali regardless of birthplace. SMM was defined using CDC 21-indicator criteria (excluding blood transfusion) and assessed during birth hospitalization and through 6 weeks postpartum. Neonatal morbidity was defined as a composite of respiratory distress syndrome, transient tachypnea of the newborn, retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, 5-minute Apgar ≤7, hypoxic-ischemic encephalopathy, NICU admission, or neonatal death. Comparisons were performed using chi-square, Fisher's exact, and t-tests as appropriate. Logistic regression estimated adjusted odds ratios (aOR) controlling for parity, mode of birth, insurance type, maternal age, and hypertensive disorders of pregnancy.

Among 63,435 index births, 7403 (11.7%) were to Black birthing individuals, including 2427 (32.9%) Somali and 4976 (67.1%) non-Somali Black individuals. Somali individuals were older, more frequently multiparous, more likely to have public insurance, and had lower epidural and cesarean birth rates (all P≤.001). SMM during birth hospitalization was similar between groups. Six-week postpartum SMM was lower among Somali births (0.5% vs 1%, P=.021; aOR: 0.53, 95% CI: 0.26-0.99). Neonatal composite morbidity was modestly lower among Somali births compared to non-Somali Black births (15.0% vs 18.7%, P=.001; aOR: 0.85, 95% CI: 0.74-0.98). Subgroup analysis demonstrated no differences in SMM or neonatal composite outcomes between Somali individuals who used interpreter services and those who did not.

In this single health system study, SMM during birth hospitalization was comparable between Somali and non-Somali Black birthing individuals, whereas postpartum severe maternal morbidity and neonatal composite morbidity were lower among Somali births. This within-diaspora comparison underscores the importance of examining heterogeneity within Black populations and suggests that maternal and neonatal outcomes may differ across Black subgroups despite shared structural disadvantage.