Self-reported racial discrimination associated with postpartum depression and low birth weight in pregnant women
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Key Takeaway
Consider racial discrimination a modifiable determinant of maternal and neonatal health requiring integration into perinatal care.
This systematic review and meta-analysis examined associations between self-reported interpersonal racial discrimination and a range of maternal and neonatal outcomes in pregnant or previously pregnant women. The analysis included 1,473,417 participants across multiple studies, though the specific setting was not reported. Most included studies were assessed as having a moderate risk of bias.
Regarding maternal outcomes, no associations were reported for hypertensive disorders of pregnancy or gestational diabetes mellitus. However, higher odds of postpartum depression were observed in cohort studies (pooled aOR 1.37, 95% CI 1.16–1.63) and cross-sectional studies (pooled aOR 1.82, 95% CI 1.35–2.47). For preterm birth, cohort studies showed no association, whereas cross-sectional studies indicated increased odds (pooled aOR 1.19, 95% CI 1.03–1.38).
Neonatal outcomes showed higher odds for low birth weight (pooled aOR 2.21, 95% CI 1.46–3.35) and very low birth weight (pooled aOR 2.70, 95% CI 1.40–5.20). Evidence for other gestational outcomes was inconsistent. No studies examined infant mortality or neonatal intensive care unit admission. Safety data, including adverse events or discontinuations, were not reported.
Limitations include the moderate risk of bias in most studies and the lack of data on infant mortality or NICU admission. The review concludes that racial discrimination should be considered a modifiable determinant of health and integrated into perinatal care to reduce inequities.
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View Original Abstract ↓
IntroductionRacial discrimination contributes to maternal and neonatal health inequities. We synthesized evidence on associations between self-reported interpersonal racial discrimination and maternal and neonatal outcomes.MethodsWe searched six major bibliographic databases from inception to September 2024, updated October 2025. We included observational epidemiological studies with comparison groups among pregnant or previously pregnant women. Outcomes included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), mode of delivery, postpartum depression (PPD), fetal growth and gestational outcomes, infant mortality, and neonatal intensive care unit (NICU) admission. Two independent reviewers screened studies and assessed risk of bias using the Newcastle-Ottawa Scales and the Appraisal Tool for Cross-Sectional Studies. Random-effects meta-analyses generated pooled adjusted odds ratios (aOR) with 95% confidence intervals (CI).ResultsFrom 20,361 records, 61 publications of 63 studies including 1,473,417 participants were included. No associations were reported for HDP or GDM. Evidence was strongest for PPD, with higher odds in cohort (pooled aOR 1·37, 95% CI 1·16–1·63) and cross-sectional studies (pooled aOR 1·82, 95% CI 1·35–2·47). Cohort studies showed no association with PTB, whereas cross-sectional studies indicated increased odds (pooled aOR 1·19, 95% CI 1·03–1·38). Higher odds were observed for low birth weight (LBW) (pooled aOR 2·21, 95% CI 1·46–3·35), and very LBW (pooled aOR 2·70, 95% CI 1·40–5·20). Evidence for other outcomes was inconsistent. No studies examined infant mortality or NICU admission. Most included studies were at moderate risk of bias.ConclusionsInterpersonal racial discrimination is associated with PPD and LBW. Racial discrimination should be considered a modifiable determinant of maternal and neonatal health and integrated into perinatal research and care to reduce inequities.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42022312529, identifier CRD42022312529.
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