216613 Black, White and Hispanic pregnancies: Clues to the social etiology of low birth weight and infant mortality

Sunday, November 7, 2010

Anne Marie O'Keefe, PhD, JD , School of Community Health, Morgan State Univertsity, Baltimore, MD
Yutaka Aoki, PhD, MS, MHS, ME , Department of Health Policy and Management, Morgan State University School of Community Health and Policy, Baltimore, MD
Jennifer Bishop, ScD, MPH , Bureau of Clinician Recruitment and Service, HRSA, Rockville, MD
Low birth weight (LBW) is the most powerful predictor of infant death. Black women are twice as likely to deliver LBW infants, and three times as likely to deliver very low birth weight infants, compared to their White counterparts. These disparities are not explained by any or all of the demographic characteristics that differentiate Black from White mothers. NHANES data on currently pregnant women from 1999-2006 were examined to explore differences among racial/ethnic groups along multiple dimensions. White pregnant women were older, more educated, wealthier, and more likely to be covered by private health insurance than their Hispanic and Black counterparts. Compared to both Whites and Hispanics, Blacks were more likely to be on Medicaid, unmarried, and to show serum cotinine levels reflective of high levels of passive and active smoking. Compared to Blacks, Hispanics were significantly less educated, less likely to have health insurance of any kind, more likely to report poor health status and less likely to report household food security, but more likely to be married.

Results corroborated the “Hispanic paradox,” i.e., despite having poorer SES and other indicators during pregnancy, Hispanic birth outcomes are much better than for Blacks and slighter better than for Whites. Results are consistent with the theory that, relative to both their White and Hispanic counterparts, Black mothers experience additional stressors without the benefit of social support, and that these differences have physiological consequences, including on birth outcomes.

The discordance between individual predictors and actual birth outcomes argues for research into the experiences that differentiate Black, White and Hispanic pregnancies. Fruitful areas for this research include the greater social support that Hispanic women enjoy (“familialism”), and the cumulative stress of racism experienced by Blacks (the “weathering” hypothesis).

Learning Areas:
Advocacy for health and health education
Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
1) Describe various statistically significant differences in the demographic, health-related and social support systems among currently pregnant Black, White and Hispanic women; 2) Describe avenues for future research to understand the substantial differences in birth outcomes that are not explained by demographic differences among racial and ethnic groups.

Keywords: Birth Outcomes, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I was the PI on this research and wrote the resulting article.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.