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Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis

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dc.contributor.author Van Daalen, K.R.
dc.contributor.author Kaiser, J.
dc.contributor.author Kebede, S.
dc.contributor.author Cipriano, Gabriela
dc.contributor.author Maimouni, H.
dc.contributor.author Olumese, E.
dc.contributor.author Chui, A.
dc.contributor.author Kuhn, I.
dc.contributor.author Oliver-Williams, C.
dc.date.accessioned 2022-09-09T18:52:23Z
dc.date.available 2022-09-09T18:52:23Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/12165
dc.description.abstract Introduction Racial discrimination has been consistently linked to various health outcomes and health disparities, including studies associating racial discrimination with patterns of racial disparities in adverse pregnancy outcomes. To expand our knowledge, this systematic review and meta-analysis assesses all available evidence on the association between self-reported racial discrimination and adverse pregnancy outcomes. Methods Eight electronic databases were searched without language or time restrictions, through January 2022. Data were extracted using a pre-piloted extraction tool. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS), and across all included studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects meta-analyses were performed on preterm birth and small for gestational age. Heterogenicity was assessed using Cochran's χ 2 test and I 2 statistic. Results Of 13 597 retrieved records, 24 articles were included. Studies included cohort, case-control and cross-sectional designs and were predominantly conducted in the USA (n=20). Across all outcomes, significant positive associations (between experiencing racial discrimination and an adverse pregnancy event) and non-significant associations (trending towards positive) were reported, with no studies reporting significant negative associations. The overall pooled odds ratio (OR) for preterm birth was 1.40 (95% CI 1.17 to 1.68; 13 studies) and for small for gestational age it was 1.23 (95% CI 0.76 to 1.99; 3 studies). When excluding low-quality studies, the preterm birth OR attenuated to 1.31 (95% CI 1.08 to 1.59; 10 studies). Similar results were obtained across sensitivity and subgroup analyses, indicating a significant positive association. Conclusion These results suggest that racial discrimination has adverse impacts on pregnancy outcomes. This is supported by the broader literature on racial discrimination as a risk factor for adverse health outcomes. To further explore this association and underlying mechanisms, including mediating and moderating factors, higher quality evidence from large ethnographically diverse cohorts is needed. en_US
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartofseries BMJ Global Health
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject child health en_US
dc.subject public health en_US
dc.subject systematic review en_US
dc.subject maternal health en_US
dc.title Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1136/bmjgh-2022-009227
dc.relation.issn 2059-7908


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