For most of this century, it has been recognized that African-Americans have a three-fold greater VLBW rate than whites. However, the mechanism underlying this phenomenon remains one of the most perplexing questions in perinatal epidemiologic research. We performed a two-year hospital-based, case-control study of impoverished African-American mothers to explore the relationship between a woman's perception of exposure to unfair treatment and VLBW. Subjects had no private medical insurance and an annual family income<$11,000/year. Cases were African-American mothers of VLBW infants. Controls were African-American mothers of non-low birth weight (>2500g, non-LBW) infants. Trained African-American interviewers administered a structured questionnaire to both subgroups. There were no differences between cases (n=25) and controls (n=60) with respect to age, education, and marital status. 100% of cases versus 64% of controls felt that racial discrimination was a problem for African-American women, p<0.05. The odds ratios (OR) of VLBW for maternal perception of exposure to racial and gender discrimination that occured during pregnancy were 1.9(0.5-6.6) and 1.7(0.3-10.5), respectively. The Table shows the distribution and OR of maternal exposure to racial discrimination in selected high-risk subgroups.

Table 1 No caption available.
Full size table

This study provides new information that the perception of exposure to unfair treatment is a possible risk factor for VLBW among high-risk, urban African-American women. More detailed studies are warranted to determine the contribution of psychophysiologic stress to the African-American:white differential in reproductive outcome.