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Racial/ethnic differences in maternal resilience and associations with low birthweight



Evaluate racial/ethnic differences in maternal resilience and its associations with low birthweight (LBW).

Study design

Retrospective cohort study of 3244 women surveyed in the Longitudinal Study of Adolescent to Adult Health. The Add Health Resilience Instrument assessed resilience. Logistic regression models explored associations between women’s resilience and risk of LBW.


Resilience scores were lowest in American Indian women. Women with the lowest resilience scores were more likely to deliver a LBW infant than highly resilient women, after adjusting for demographic and health-related factors (aOR 1.58 95% CI 1.05–2.38). The risk-adjusted rate of LBW among highly resilient Black women (15.6%) was significantly higher than the risk-adjusted rate of LBW among highly resilient white women (9.1%, p = 0.01) and highly resilient Hispanic women (8.6%, p = 0.04).


Resilience scores differ significantly among women of different race and ethnicity but do not appear to entirely account for racial/ethnic disparities in LBW.

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Fig. 1: Differences in the risk-adjusted rate of LBW by race/ethnicity and resilience tertile grouping.

Data availability

This study utilized both the public use and restricted-use data provided by the original Add Health investigative team. Information on how to obtain the Add Health data files is available on the Add Health website (

Code availability

We used STATA version 15 (StataCorp LLC, College Station, TX) for all analyses. The codes used for the analyses in this paper are available upon request.


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This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. No direct support was received from grant P01-HD31921 for this study, however we would like to acknowledge the Division of Neonatology at the Children’s Hospital of Philadelphia for administrative support and Ms. Ali Chandler for her assistance in preparing this paper.


This research uses data from Add Health, which was originally funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. The authors of this paper received no additional funding to complete this study.

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Using their own language, all authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Diana Montoya-Williams.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was deemed exempt by the local Institutional Review Board as it uses de-identified, publicly available data. This study was performed in accordance with the Declarations of Helsinki.

Informed consent

All original participants provided written, informed consent to participate. The written consent informed participants that results, in aggregate, would be published.

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Montoya-Williams, D., Passarella, M., Grobman, W.A. et al. Racial/ethnic differences in maternal resilience and associations with low birthweight. J Perinatol 41, 196–203 (2021).

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