Experiences of Racism and Preterm Birth: Findings from a Pregnancy Risk Assessment Monitoring System, 2004 through 2012

Background: Racial disparities in birth outcomes represent a significant public health concern in the United States. Factors associated with racism have been posited as a mechanism underlying these disparities. Yet, findings from previous studies are mixed and based on small, geographically limited samples. This study aims to examine the relationship between experiences of racism and preterm birth in a population-based sample and to explore the role of adequacy of prenatal care within that relationship. Methods: Data from the 2004 through 2012 Pregnancy Risk Assessment Monitoring System were analyzed. The sample included non-Hispanic Black mothers from 11 states and New York City who delivered neonates from 2004 to 2012 (n = 11,582). Survey-weighted regression analyses were used to examine the association between women feeling upset by experiences of racism in the 12 months before delivery and subsequent preterm birth. Adequacy of prenatal care was tested as an effect modifier. Results: Feeling upset by experiences of racism was significantly associated with greater odds of preterm birth (adjusted odds ratio, 1.29; 95% CI, 1.04–1.59). Results from interaction models revealed that the associations of experiences of racism with preterm birth differed by level of prenatal care, although the interaction term was not significant. Conclusions: Findings suggest that, for non-Hispanic Black women, the emotional effect of experiences of racism may contribute to the risk of preterm birth. Future studies should consider the role of adequate prenatal care in this relationship. Racism is an important public health problem with a measurable impact on preterm birth and should be addressed to eliminate racial inequities in birth outcomes.