What Causes Racial Disparities in Very Preterm Birth? A Biosocial Perspective
Open accessAbstract
Very preterm birth (<32 weeks' gestation) occurs in approximately 2% of livebirths but is a leading cause of infant mortality and morbidity in the United States. African-American women have a 2-fold to 3-fold elevated risk compared with non-Hispanic white women for reasons that are incompletely understood. This paper reviews the evidence for the biologic and social patterning of very preterm birth, with attention to leading hypotheses regarding the etiology of the racial disparity. A systematic review of the literature in the MEDLINE, CINAHL, PsycInfo, and EMBASE indices was conducted. The literature to date suggests a complex, multifactorial causal framework for understanding racial disparities in very preterm birth, with maternal inflammatory, vascular, or neuroendocrine dysfunction as proximal pathways and maternal exposure to stress, racial differences in preconceptional health, and genetic, epigenetic, and gene-environment interactions as more distal mediators. Interpersonal and institutionalized racism are mechanisms that may drive racially patterned differences. Current literature is limited in that research on social determinants and biologic processes of prematurity has been generally disconnected. Improved etiologic understanding and the potential for effective intervention may come with better integration of these research approaches.
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Many studies demonstrate an association between stress or depression and preterm birth, while others suggest racial disparity is an underlying factor.
“Although many studies demonstrate an association [10-15] others suggest that racial disparity [14,16,17] is an underlying factor.”
From The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study (2011) · cites this paper as [17]
The ‘Epidemiology of stress and prematurity’ passages report associations between stress and preterm birth and describe black–white differences in risk. They also report that accounting for experiences of discrimination reduced the black–white disparity. The paper treats racial disparity as an outcome to explain, however, rather than establishing the disparity itself as an underlying cause of preterm birth. (LLM, conf=0.78)
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BackgroundPreterm Birth Risk and Maternal Nativity, Ethnicity, and Race
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- Authors
- Kramer, M. R., & Hogue, C. R.
- Affiliations
- Emory University (US)
- ORCID
- Kramer, M. R.
- Venue
- Epidemiologic Reviews
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-05-28
- Volume
- 31
- Issue
- 1
- Pages
- 84-98
- ISSN
- 0193-936X (ISSN-L)
- 1478-6729
- PMC
- PMC4361938
- OpenAlex
- W2165878225
- Semantic Scholar
- 5c435a8ed2a37665677d6a381c94333c33843848
- Cited by
- 255
- References
- 183
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 12 · 2023: 11 · 2022: 33 · 2021: 16 · 2020: 21 · 2019: 24 · 2018: 10 · 2017: 17 · 2016: 13 · 2015: 17 · 2014: 9 · 2013: 16 · 2012: 18
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Epidemiologic Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- University Libraries (University of Maryland) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- U.S. Public Health Service (T03MC07651)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD052460)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Keywords
- very preterm birth, racial disparities, African American women, biosocial model, maternal inflammation, neuroendocrine dysfunction, maternal stress, epigenetics, gene-environment interaction, institutional racism, interpersonal racism, social determinants of health
- MeSH terms
- Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Social Environment, Stress, Psychological, United States, Racial Groups, Premature Birth
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