Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress
Open accessAbstract
OBJECTIVE: To assess the relationships between self-reported psychosocial stress and preterm birth, hypertensive disease of pregnancy, and small-for-gestational-age (SGA) birth and to assess the extent to which these relationships account for racial and ethnic disparities in these adverse outcomes. METHODS: Self-reported measures of psychosocial stress (perceived stress, depression, racism, anxiety, resilience, and social support) were collected during pregnancy among a racially and ethnically diverse cohort of women enrolled in a prospective observational study of nulliparous women with singleton pregnancies, from eight clinical sites across the United States, between October 2010 and May 2014. The associations of preterm birth, hypertensive disease of pregnancy, and SGA birth with the self-reported measures of psychosocial stress as well as with race and ethnicity were evaluated. RESULTS: The study included 9,470 women (60.4% non-Hispanic white, 13.8% non-Hispanic black, 16.7% Hispanic, 4.0% Asian, and 5.0% other). Non-Hispanic black women were significantly more likely to experience any preterm birth, hypertensive disease of pregnancy, and SGA birth than were non-Hispanic white women (12.2% vs 8.0%, 16.7% vs 13.4%, and 17.2% vs 8.6%, respectively; P <.05 for all). After adjusting for potentially confounding factors, including the six different psychosocial factors singly and in combination, non-Hispanic black women continued to be at greater risk of any preterm birth and SGA birth compared with non-Hispanic white women. CONCLUSION: Among a large and geographically diverse cohort of nulliparous women with singleton gestations, non-Hispanic black women are most likely to experience preterm birth, hypertensive disease of pregnancy, and SGA birth. These disparities were not materially altered for preterm birth or SGA birth by adjustment for demographic differences and did not appear to be explained by differences in self-reported psychosocial factors.
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Non-Hispanic Black people have a higher risk for obstetric complications including HDP than White pregnant people.
“Additionally, 67% of participants identified as White, which limits generalizability to non-Hispanic Black people, who have a higher risk for obstetric complications including HDP than White pregnant people.36”
From Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders. (2024) · cites this paper as [36]
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Parchem, J. G., Gupta, M., Chen, H.-Y., Wagner, S., Figueroa, H. M., & Chauhan, S. P. (2020) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003730 · Cited by 28 · see citing works
Maternal psychosocial functioning, obstetric health history, and newborn telomere length
Enlow, M. B., Petty, C. R., Hacker, M. R., & Burris, H. H. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.105043 · Cited by 27 · see citing works
“Davidson, 2003), which has been used in other pregnancy studies (Grobman et al., 2018; Johnson et al., 2018).”
MethodPereira, G. M. V., Pimentel, V. M., Surita, F. G., da Silva, A. F., & Brito, L. G. O. (2022) · Sao Paulo Medical Journal · doi:10.1590/1516-3180.2021.0505.r1.07042022 · Cited by 26 · see citing works
Koning, S. M., & Ehrenthal, D. B. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100460 · Cited by 27 · see citing works
“First, our findings agree with other US-based studies finding wide disparities in birth outcomes by race and SEP (Almeida et al., 2018; Amjad et al., 2019; Blumenshine et al., 2010; Braveman et al., 2015; Culhane & Goldenberg, 2011; Grobman et al., 2018).”
BackgroundResultPredictors of Developmental Patterns of Obesity in Young Children
O’Connor, T. G., Williams, J. G., Blair, C., Gatzke‐Kopp, L. M., Francis, L. A., & Willoughby, M. T. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2020.00109 · Cited by 25 · see citing works
Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer
Nitecki, R., Clapp, M. A., Fu, S., Lamiman, K., Melamed, A., Brady, P. C., Kaimal, A. J., Carmen, M. G. D., Woodard, T. L., Meyer, L. A., et al. (2021) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004394 · Cited by 26 · see citing works
The Fourth Trimester: Pregnancy as a Predictor of Cardiovascular Disease
Wu, P., Park, K. E., & Gulati, M. (2021) · European Cardiology Review · doi:10.15420/ecr.2021.18 · Cited by 29 · see citing works
Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype
Erickson, E. N., Lee, C. S., & Carlson, N. S. (2020) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13104 · Cited by 25 · see citing works
Coté, J. J., Badura-Brack, A. S., Walters, R. W., Dubay, N. G., & Bredehoeft, M. (2020) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2020.01.003 · Cited by 25 · see citing works
Shah, N. S., Harrington, K. A., Huang, X., Cameron, N. A., Yee, L. M., & Khan, S. S. (2022) · JAMA Cardiology · doi:10.1001/jamacardio.2022.1378 · Cited by 23 · see citing works
Kett, P. M., Eijk, M. S. V., Guenther, G. A., & Skillman, S. M. (2022) · Perspectives on Sexual and Reproductive Health · doi:10.1363/psrh.12203 · Cited by 23 · see citing works
Air Pollution and Racial Disparities in Pregnancy Outcomes in the United States: A Systematic Review
Dzekem, B. S., Aschebrook‐Kilfoy, B., & Olopade, C. O. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-023-01539-z · Cited by 24 · see citing works
“These findings are consistent with studies conducted in other countries [13, 14, 52].”
BackgroundResultCarlson, N. S., Carlson, M. S., Erickson, E. N., Higgins, M. K., Britt, A. J., & Amore, A. D. (2023) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-023-05667-6 · Cited by 23 · see citing works
Transcending Language Barriers in Obstetrics and Gynecology
Truong, S., Foley, O., Fallah, P. N., Lalla, A., Osterbur, M. L., Boatin, A. A., Mitchell, C. M., Bryant, A., & Molina, R. L. (2023) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005334 · Cited by 23 · see citing works
New directions in necrotizing enterocolitis with early-stage investigators
Markel, T. A., Martin, C. A., Chaaban, H., Canvasser, J., Tanner, H., Denchik, H., & Good, M. L. (2020) · Pediatric Research · doi:10.1038/s41390-020-1078-0 · Cited by 22 · see citing works
“Excessive psychological stress during pregnancy is harmful to the fetus and increases the incidence of poor neuropsychological outcomes.(12) Children subjected to gestational stress have higher rates of depression, ADHD, autism, and bipolar disorder.”
BackgroundWakefield, C., & Frasch, M. G. (2023) · AJPM Focus · doi:10.1016/j.focus.2023.100100 · Cited by 21 · see citing works
“Full details of the study protocol have been previously published.(13,14) In brief, women were eligible for enrollment if they had a viable singleton gestation, had no previous pregnancy that lasted more than 20 weeks of gestation, and were between 6 weeks 0 days gestation and 13 weeks 6 days gestation at recruitment.”
MethodObstetrics and Gynecology and Reparations: The Debt We Owe (and Continue to Accumulate)
Swanson, M. L., Whetstone, S., Illangasekare, T., & Autry, A. M. (2021) · Health Equity · doi:10.1089/heq.2021.0015 · Cited by 21 · see citing works
Spann, M. N., Alleyne, K., Holland, C. M., Davids, A., Pierre-Louis, A., Bang, C., Oyeneye, V., Kiflom, R., Shea, E., Cheng, B., et al. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01765-3 · Cited by 22 · see citing works
“These experiences have unique and speci fi c effects on psychological well-being that are not solely moderated or mediated by stress or depression [25].”
BackgroundHypertension Management in Pregnancy
Ryan, K. D., McGrath, L. B., & Brookfield, K. (2024) · Annual Review of Medicine · doi:10.1146/annurev-med-050423-085626 · Cited by 20 · see citing works
Martenies, S. E., Zhang, M., Corrigan, A. E., Kvit, A., Shields, T., Wheaton, W. D., Bastain, T. M., Breton, C. V., Dabelea, D., Habre, R., et al. (2022) · Health & Place · doi:10.1016/j.healthplace.2022.102858 · Cited by 19 · see citing works
Use of E-Cigarettes and Cigarettes During Late Pregnancy Among Adolescents
Wen, X., Liu, L., Moe, A. A., Ormond, I. K., Shuren, C. C., Scott, I. N., Ozga, J. E., Stanton, C. A., Ruybal, A. L., Hart, J. L., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.47407 · Cited by 19 · see citing works
Scoping Review of Microaggression as an Experience of Racism and Perinatal Health Outcomes
Crawford, A. D., Darilek, U., McGlothen‐Bell, K., Gill, S. L., Lopez, E., & Cleveland, L. M. (2022) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2021.12.007 · Cited by 18 · see citing works
Barry, Y., Strat, Y. L., Azria, É., Gorza, M., Pilkington, H., Vandentorren, S., Gallay, A., & Regnault, N. (2022) · BMC Public Health · doi:10.1186/s12889-022-13246-1 · Cited by 18 · see citing works
Deliveries Among Patients Aged 11–19 Years and Risk for Adverse Pregnancy Outcomes
Staniczenko, A. P., Wen, T., Cepin, A. G., Guglielminotti, J. R., Logue, T. C., Krenitsky, N. M., Huang, Y., D’Alton, M. E., & Friedman, A. M. (2022) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004807 · Cited by 18 · see citing works
Nieves, C. I., Borrell, L. N., Evans, C. R., Jones, H. E., & Huynh, M. (2023) · Health & Place · doi:10.1016/j.healthplace.2023.103029 · Cited by 18 · see citing works
Psychosocial Stressors as a Determinant of Maternal Cardiovascular Health During Pregnancy
Boyer, T. M., Avula, V. R., Minhas, A., Vaught, A. “. J., Sharma, G. V., & Gemmill, A. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.06.046 · Cited by 18 · see citing works
Environmental Justice Index and adverse pregnancy outcomes
Pozzo, J. D., Kouba, I., Álvarez, A., O’Sullivan-Bakshi, T., Krishnamoorthy, K., & Blitz, M. J. (2024) · AJOG Global Reports · doi:10.1016/j.xagr.2024.100330 · Cited by 18 · see citing works
Household food insecurity and antepartum depression in the National Children's Study
Richards, M., Weigel, M. M., Li, M., Rosenberg, M. S., & Ludema, C. (2020) · Annals of Epidemiology · doi:10.1016/j.annepidem.2020.01.010 · Cited by 19 · see citing works
Life‐Course Reproductive History and Cardiovascular Risk Profile in Late Mid‐Life: The CARDIA Study
Lane‐Cordova, A. D., Gunderson, E. P., Greenland, P., Catov, J. M., Lewis, C. E., Gabriel, K. P., Wellons, M., & Carnethon, M. R. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.014859 · Cited by 17 · see citing works
Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity
Purohit, A. M., Oyeka, C. P., Khan, S. S., Toscano, M. A., Nayak, S., Lawson, S. M., Blumenthal, R. S., & Sharma, G. V. (2023) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-023-00356-9 · Cited by 18 · see citing works
A Scoping Review of Preterm Birth Risk Factors
Tang, I., Mallia, D., Yan, Q. J., Pe’er, I., Raja, A., Salleb-Aouissi, A., & Wapner, R. J. (2023) · American Journal of Perinatology · doi:10.1055/s-0043-1775564 · Cited by 18 · see citing works
Self-citationPaternal race/ethnicity and risk of adverse birth outcomes in the United States, 1989–2013
Li, Y., Luo, Z., Holzman, C., Liu, H., & Margerison, C. E. (2018) · AIMS Public Health · doi:10.3934/publichealth.2018.3.312 · Cited by 16 · see citing works
Marijuana use and perinatal outcomes in obstetric patients at a safety net hospital
Sasso, E. B., Bolshakova, M., Bogumil, D. D., Johnson, B., Komatsu, E. J., Sternberg, J. L., Cortessis, V. K., & Mullin, P. (2021) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2021.09.015 · Cited by 15 · see citing works
Marjan, V. R., Blockeel, C., Bonduelle, M., Buysse, A., Roelants, M., Verheyen, G., Tournaye, H. J., Hes, F. J., & Belva, F. (2021) · Human Reproduction Open · doi:10.1093/hropen/hoab002 · Cited by 16 · see citing works
The Effects of Gestational Psychological Stress on Neonatal Mouse Intestinal Development
Shah, J., Deas, S. B., Ren, C., Jilling, T., Brawner, K. M., & Martin, C. A. (2018) · Journal of Surgical Research · doi:10.1016/j.jss.2018.10.054 · Cited by 15 · see citing works
Associations of maternal diet with infant adiposity at birth, 6 months and 12 months
Gonzalez-Nahm, S., Hoyo, C., Østbye, T., Neelon, B., Allen, C., & Benjamin‐Neelon, S. E. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030186 · Cited by 15 · see citing works
Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework
Ruyak, S. L., & Kivlighan, K. T. (2021) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2021.04.012 · Cited by 16 · see citing works
“Maternal outcomes related to these stressors may include mood disorders, complications such as hyperemesis and hypertensive disorders, and preterm labor (Grobman et al., 2018; Mukherjee et al., 2017).”
BackgroundPredictors of readmission for postpartum preeclampsia
McLaren, R. A., Magenta, M., Gilroy, L., Duarte, M. G., Narayanamoorthy, S., Weedon, J., & MINKOFF, H. L. (2021) · Hypertension in Pregnancy · doi:10.1080/10641955.2021.1975737 · Cited by 15 · see citing works
“As the focus on racial inequities in health-care increases, it is important that these data are taken into consideration when designing community-level interventions aimed at preventing and better managing HDP, which remains a major threat to the health of black women (15).”
BackgroundErickson, E. N., & Carlson, N. S. (2022) · Reproductive Sciences · doi:10.1007/s43032-022-00913-2 · Cited by 15 · see citing works
“While latent class analysis has been used to examine health disparities and the influence of psychosocial stress in other perinatal contexts [67], we believe this is the first study to examine maternal morbidity by individuals’ intersectional SDoH phenotypes.”
Gerson, K. D., McCarthy, C., Ravel, J., Elovitz, M. A., & Burris, H. H. (2020) · American Journal of Perinatology · doi:10.1055/s-0040-1717098 · Cited by 14 · see citing works
Self-citationOmowale, S. S., Gary‐Webb, T. L., Wallace, M. L., Wallace, J. M., Rauktis, M. E., Eack, S. M., & Méndez, D. D. (2022) · Women s Health · doi:10.1177/17455057221126808 · Cited by 15 · see citing works
Lee, K., Pellowski, J. A., Brayboy, L. M., Thompson, K. D., & DUNSIGER, S. I. (2024) · Maternal and Child Health Journal · doi:10.1007/s10995-023-03885-0 · Cited by 14 · see citing works
“Psychosocial factors are particular of interest in the context of hypertension in pregnancy, since stress can impart biological changes to the body, and is associated with hypertension development (Giurgescu et al., 2015; Grobman et al., 2018 ; László et al., 2013; Liu et al., 2017; Spruill, 2010).”
Wang, Z., Zhang, C., Williams, P. L., Bellavia, A., Wylie, B. J., Hacker, M. R., Kannan, K., Bloom, M. S., Hunt, K. J., Hauser, R. B., et al. (2022) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2022.113978 · Cited by 14 · see citing works
Palatnik, A., Garacci, E., Walker, R. J., Ozieh, M. N., Williams, J. S., & Egede, L. E. (2019) · American Journal of Perinatology · doi:10.1055/s-0039-3400995 · Cited by 14 · see citing works
Preterm birth among pregnant persons with severe acute respiratory syndrome Coronavirus 2 infection
Newton, S. M., Reeves, E. L., Olsen, E. O., Woodworth, K. R., Farr, S. L., Galang, R. R., Reynolds, M. R., Harvey, E., Shi, J. C., Nestoridi, E., et al. (2022) · Journal of Perinatology · doi:10.1038/s41372-022-01467-6 · Cited by 14 · see citing works
“Preterm birth rates are higher among non-Hispanic Black persons than for White non-Hispanic, Asian, or Hispanic persons in the United States [28, 29].”
BackgroundGonzalez-Nahm, S., Marchesoni, J., Maity, A., Maguire, R. L., House, J. S., Tucker, R., Atkinson, T., Murphy, S. K., & Hoyo, C. (2022) · Current Developments in Nutrition · doi:10.1093/cdn/nzac146 · Cited by 16 · see citing works
“In addition, infants born to Black/African American mothers are more likely to have a low birth weight or be born preterm (42, 43).”
BackgroundStructural racism, nativity and risk of adverse perinatal outcomes among Black women
McKenzie‐Sampson, S., Baer, R. J., Jelliffe‐Pawlowski, L. L., Karasek, D. A., Riddell, C. A., Torres, J. M., & Blebu, B. E. (2023) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.13032 · Cited by 13 · see citing works
Conti-Ramsden, F. I., de Marvao, A., & Chappell, L. C. (2025) · Reproduction · doi:10.1530/rep-25-0049 · Cited by 13 · see citing works
Arvizo, C., & Garrison, E. (2019) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000566 · Cited by 13 · see citing works
West, R. L., DiMeo, A., Langer, A., Shah, N. T., & Molina, R. L. (2022) · Maternal and Child Health Journal · doi:10.1007/s10995-021-03363-5 · Cited by 12 · see citing works
- Authors
- Grobman, W. A., Parker, C. B., Willinger, M., Wing, D. A., Silver, R. M., Wapner, R. J., Simhan, H. N., Parry, S., Mercer, B. M., Haas, D. M., Peaceman, A. M., Hunter, S., Wadhwa, P., Elovitz, M. A., Foroud, T., Saade, G., Reddy, U. M., & for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*
- Affiliations
- Northwestern University (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2018-02
- Volume
- 131
- Issue
- 2
- Pages
- 328-335
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC5785441
- OpenAlex
- W2783803193
- Cited by
- 260
- References
- 22
- Citations by year
- 2026: 17 · 2025: 29 · 2024: 27 · 2023: 41 · 2022: 56 · 2021: 45 · 2020: 28 · 2019: 10 · 2018: 5
- FWCI
- 20.82
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- University of Pennsylvania (U10 HD063046, U10 HD063020, U10 HD063047, U10 HD063041, U10 HD063072, U10 HD063036, U10 HD063053, U10 HD063037, U10HD063048)
- Northwestern University (U10 HD063053, U10 HD063020, U10 HD063046, U10 HD063048, U10 HD063072, U10 HD063036, U10 HD063047, U10 HD063037, U10 HD063041)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD063053, U10HD063046, U10HD063020, U10HD063072, HD063036, U10HD063048, U10HD063041, U10HD063047, U10HD063036, U10HD063037, UG1HD040512)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- racial disparities, psychosocial stress, preterm birth, hypertensive disorders of pregnancy, small-for-gestational-age birth, non-Hispanic Black women, nulliparous women, perceived stress, racism, depression, anxiety, resilience, social support, pregnancy outcomes
- MeSH terms
- Adult, Ethnicity, Female, Humans, Infant, Newborn, Infant, Small for Gestational Age, Pregnancy, Pregnancy Outcome, Prospective Studies, Stress, Psychological, White People, Hypertension, Pregnancy-Induced, Premature Birth, Health Status Disparities, Self Report
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