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Race, Ethnicity & Perinatal Outcomes

In a global study of high- and upper-middle-income countries, babies born to Black women in underserved groups “had consistently poorer perinatal outcomes than White women after adjusting for maternal characteristics, although the risks varied for other groups,” investigators conclude. The article is part of a special issue on advancing racial and ethnic equity in science, medicine, and health.

The individual participant data (IPD) meta-analysis initially included findings from 94 studies, 53 countries, and 4,539,640 pregnancies stored in the International Prediction of Pregnancy Complications Network. Studies reported perinatal outcomes (neonatal death, stillbirth, preterm birth, and small-for-gestational-age babies) in at least 2 racial or ethnic groups (White, Black, south Asian, Hispanic, or other).

Based on primary outcomes of neonatal mortality and stillbirth, the study found: “51 studies from 20 high-income and upper-middle-income countries, comprising 2,198,655 pregnancies, were eligible for inclusion in this IPD meta-analysis. Neonatal death was twice as likely in babies born to Black women than in babies born to White women (OR 2.00, 95% CI 1.44–2.78), as was stillbirth (2.16, 1.46–3.19), and babies born to Black women were at increased risk of preterm birth (1.65, 1.46–1.88) and being small for gestational age (1.39, 1.13–1.72). Babies of women categorised as Hispanic had a three-times increased risk of neonatal death (OR 3.34, 95% CI 2.77–4.02) than did those born to White women, and those born to south Asian women were at increased risk of preterm birth (OR 1.26, 95% CI 1.07–1.48) and being small for gestational age (1.61, 1.32–1.95). The effects of race and ethnicity on preterm birth and small-for-gestational-age babies did not vary across regions.”

Editorial: “Ongoing discussions regarding the use of the terms race, ethnicity, and ancestry in biomedicine reflect the persistent misunderstanding of the definitions of these terms and their true associations with pathogenic genetic variants,” write authors of a Viewpoint article. “In fact, structural racism—or the way policies established through legacies of slavery and European colonisation encourage ongoing racialised oppression in all parts of society—produces environmental but non-uniform distribution of inequities. These inequities become embodied in the individual, influencing hormonal activity, epigenetics, and gene expression alongside reduced health-care access and health-care quality to produce health inequity. Misuse and conflation of the terms race, ethnicity, and ancestry are restricting progress in understanding health disparities. These terms are all socially constructed concepts with no fixed biological meaning, although variable experiences of racialisation can produce health inequities via physiological responses to racial oppression. Reliance on race, ethnicity, and ancestry as surrogates for pathogenic alleles of complex disease in biomedical research and clinical practice risks identification of spurious associations, misdiagnosis of disease risks, and missed opportunities to fund research that can potentially identify the true causes of health disparities. Practicing race-conscious medicine by emphasising racism rather than poorly defined sociopolitical categories can reveal the underlying causes of racialised health inequities and the appropriate targets of intervention.”

Source: Lancet