Examine the risk of adverse perinatal outcomes among the United States (US)-born and foreign-born Black women in California.
The study comprised all singleton live births to Black women in California between 2011 and 2017. We defined maternal nativity as US-born or foreign-born. Using Poisson regression, we computed risk ratios (RR) and 95% confidence intervals (CI) for three adverse perinatal outcomes: preterm birth, small for gestational age deliveries, and infant mortality.
Rates of adverse perinatal outcomes were significantly higher among US-born Black women. In adjusted models, US-born Black women experienced an increased risk of preterm birth (RR 1.51, 95% CI 1.39, 1.65) and small for gestational age deliveries (RR 1.52, 95% CI 1.41, 1.64), compared to foreign-born Black women.
Future studies should consider experiences of racism across the life course when exploring heterogeneity in the risk of adverse perinatal outcomes by nativity among Black women in the US.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $8.25 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018;61:387–99.
Wallace ME, Mendola P, Liu D, Grantz KL. Joint effects of structural racism and income inequality on small-for-gestational-age birth. Am J Public Health. 2015;105:1681–8.
Manuck TA. Racial and ethnic differences in preterm birth: a complex, multifactorial problem. Semin Perinatol. 2017;41:511–8.
Thompson JA, Suter MA. Estimating racial health disparities among adverse birth outcomes as deviations from the population rates. BMC Pregnancy Childbirth. 2020;20:155.
Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, et al. Children born small for gestational age: differential diagnosis, molecular genetic evaluation, and implications. Endocr Rev. 2018;39:851–94.
Kozhimannil KB, Hardeman RR, Alarid-Escudero F, Vogelsang C, Blauer-Peterson C, Howell EA. Modeling the cost effectiveness of doula care associated with reductions in preterm birth and cesarean delivery. Birth. 2016;43:20–7.
Collins JW, David RJ. Racial disparity in low birth weight and infant mortality. Clin Perinatol. 2009;36:63–73.
Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the Black-White gap in birth outcomes: a life-course approach. Ethn Dis. 2010;20:62–76.
Scott KA, Britton L, McLemore MR. The ethics of perinatal care for black women: dismantling the structural racism in “mother blame” narratives. J Perinat Neonatal Nurs. 2019;33:108–15.
Wallace M, Crear-Perry J, Richardson L, Tarver M, Theall K. Separate and unequal: structural racism and infant mortality in the US. Health Place. 2017;45:140–4.
Rankin KM, David RJ, Collins JW. African American women’s exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethn Dis. 2011;21:370–6.
Almeida J, Bécares L, Erbetta K, Bettegowda VR, Ahluwalia IB. Racial/ethnic inequities in low birth weight and preterm birth: the role of multiple forms of stress. Matern Child Health J. 2018;22:1154–63.
Collins JW, David RJ, Handler A, Wall S, Andes S. Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. Am J Public Health. 2004;94:2132–8.
Chambers BD, Baer RJ, McLemore MR, Jelliffe-Pawlowski LL. Using index of concentration at the extremes as indicators of structural racism to evaluate the association with preterm birth and infant mortality-California, 2011–2012. J Urban Health. 2019;96:159–70.
Prather C, Fuller TR, Marshall KJ, Jeffries WL. The impact of racism on the sexual and reproductive health of African American women. J Women’s Health. 2016;25:664–71.
Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.
Howard DL, Marshall SS, Kaufman JS, Savitz DA. Variations in low birth weight and preterm delivery among Blacks in relation to ancestry and nativity: New York City, 1998–2002. Pediatrics. 2006;118:e1399–405.
Elo IT, Vang Z, Culhane JF. Variation in birth outcomes by mother’s country of birth among non-Hispanic black women in the United States. Matern Child Health J. 2014;18:2371–81.
DeSisto CL, Hirai AH, Collins JW, Rankin KM. Deconstructing a disparity: explaining excess preterm birth among U.S.-born black women. Ann Epidemiol. 2018;28:225–30.
Elsayed A, Amutah-Onukagha NN, Navin L, Gittens-Williams L, Janevic T. Impact of immigration and duration of residence in US on length of gestation among black women in Newark, New Jersey. J Immigr Minor Health. 2019;21:1095–101.
Waters MC, Kasinitz P, Asad AL. Immigrants and African Americans. Annu Rev Socio. 2014;40:369–90.
Oliver EA, Klebanoff M, Yossef-Salameh L, Oza-Frank R, Moosavinasab S, Reagan P, et al. Preterm birth and gestational length in four race–nativity groups, including Somali Americans. Obstet Gynecol. 2018;131:281.
Pallotto EK, Collins JW, David RJ. Enigma of maternal race and infant birth weight: a population-based study of US-born black and Caribbean-born black women. Am J Epidemiol. 2000;151:1080–5.
Stein CR, Savitz DA, Janevic T, Ananth CV, Kaufman JS, Herring AH, et al. Maternal ethnic ancestry and adverse perinatal outcomes in New York City. Am J Obstet Gynecol. 2009;201:584.e1–584.e9.
Migration Policy Institute. Washington DC; c2001-2020. Diverse Streams: African Migration to the United States. 2012. https://www.migrationpolicy.org/research/CBI-african-migration-united-states. Accessed 16 Jul 2020.
Migration Policy Institute. Washington DC; c2001-2020. A Demographic Profile of Black Caribbean Immigrants in the United States. 2012. https://www.migrationpolicy.org/research/CBI-demographic-profile-black-caribbean-immigrants. Accessed 16 Jul 2020.
California’s Office of Statewide Health Planning and Development. Sacramento; c2020. Research Data Request Information. 2020. https://oshpd.ca.gov/data-and-reports/research-data-request-information/.
Schmitt SK, Sneed L, Phibbs CS. Costs of newborn care in California: a population-based study. Pediatrics. 2006;117:154–60.
MacDorman M, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004–2017. Birth. 2019;46:279–88.
Murray SR, Stock SJ, Cowan S, Cooper ES, Norman JE. Spontaneous preterm birth prevention in multiple pregnancy. Obstet Gynaecol. 2018;20:57–63.
Imaizumi Y. Infant mortality rates in single, twin and triplet births, and influencing factors in Japan, 1995–98. Paediatr Perinat Epidemiol. 2001;15:346–51.
Usta IM, Harb TS, Rechdan JB, Suidan FG, Nassar AH. The small-for-gestational-age twin: blessing or curse? J Reprod Med. 2005;50:491–5.
Dolan SM, Gross SJ, Merkatz IR, Faber V, Sullivan LM, Malone FD, et al. The contribution of birth defects to preterm birth and low birth weight. Obstet Gynecol. 2007;110:318–24.
Wojcik MH, Schwartz TS, Thiele KE, Paterson H, Stadelmaier R, Mullen TE, et al. Infant mortality: the contribution of genetic disorders. J Perinatol. 2019;39:1611–9.
Baer RJ, Norton ME, Shaw GM, Flessel MC, Goldman S, Currier RJ, et al. Risk of selected structural abnormalities in infants after increased nuchal translucency measurement. Am J Obstet Gynecol. 2014;211:675.e1–19.
Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics. 2014;133:844–53.
Melnikow J, Evans E, Xing G, Durbin S, Ritley D, Daniels B, et al. Primary care access to new patient appointments for California Medicaid enrollees: a simulated patient study. Ann Fam Med. 2020;18:210–7.
Kotelchuck M. The adequacy of prenatal care utilization index: its US distribution and association with low birthweight. Am J Public Health. 1994;84:1486–9.
Mason SM, Kaufman JS, Emch ME, Hogan VK, Savitz DA. Ethnic density and preterm birth in African-, Caribbean-, and US-born non-Hispanic black populations in New York City. Am J Epidemiol. 2010;172:800–8.
Collins JW, Soskolne GR, Rankin KM, Bennett AC. Differing first year mortality rates of term births to White, African-American, and Mexican-American US-born and foreign-born mothers. Matern Child Health J. 2013;17:1776–83.
David R, Collins J. Disparities in infant mortality: what’s genetics got to do with it? Am J Public Health. 2007;97:1191–7.
Dominguez TP, Strong EF, Krieger N, Gillman MW, Rich-Edwards JW. Differences in the self-reported racism experiences of US-born and foreign-born Black pregnant women. Soc Sci Med. 2009;69:258–65.
Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS ONE. 2015;10:e0138511.
Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, et al. Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women. Ann N Y Acad Sci. 2019;1457:104–27.
Giscombé CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131:662–83.
Akresh IR, Frank R. Health selection among new immigrants? Am J Public Health. 2008;98:2058–64.
Ro A, Fleischer NL, Blebu B. An examination of health selection among U.S. immigrants using multi-national data. Soc Sci Med. 2016;158:114–21.
Owens DC, Fett SM. Black maternal and infant health: historical legacies of slavery. Am J Public Health. 2019;109:1342–5.
Hamad R, Rehkopf DH. Poverty, pregnancy, and birth outcomes: a study of the earned income tax credit. Paediatr Perinat Epidemiol. 2015;29:444–52.
Surkan PJ, Dong L, Ji Y, Hong X, Ji H, Kimmel M, et al. Paternal involvement and support and risk of preterm birth: findings from the Boston Birth Cohort. J Psychosom Obstet Gynaecol. 2019;40:48–56.
This study was supported by funding from the California Preterm Birth Initiative. The funder had no role in the following: study conception/design, data analysis and interpretation, manuscript composition and the decision to submit for publication. This study was presented virtually as a poster presentation at the 33rd Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research.
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
McKenzie-Sampson, S., Baer, R.J., Blebu, B.E. et al. Maternal nativity and risk of adverse perinatal outcomes among Black women residing in California, 2011–2017. J Perinatol (2021). https://doi.org/10.1038/s41372-021-01149-9