Perceptions of Racial Discrimination and the Risk of Preterm Birth

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Abstract
Background. Because racial discrimination might contribute to their excess of preterm births, we assessed experiences of racism in relation to preterm birth among African-American women. Methods. We used data from the Black Women’s Health Study, a follow-up study of African-American women begun in 1995. Data on subsequent singleton births were obtained using follow-up questionnaires in 1997 and 1999; nine questions about experiences of racism were asked in 1997. We compared mothers of 422 babies born 3 or more weeks early (because of premature labor for unknown reasons or rupture of membranes) with mothers of 4544 babies of longer gestation. We used generalized estimating equation models to estimate odds ratios (ORs) for preterm birth, controlling potential confounders. Results. The adjusted ORs for preterm birth were 1.3 (95% confidence interval [CI] = 1.1–1.6) for women who reported unfair treatment on the job and 1.4 (1.0–1.9) for women who reported that people acted afraid of them at least once a week. Overall ORs for the seven other racism questions were close to 1.0. Among 491 women with ≤12 years of education, ORs were 2.0 or greater for four racism variables. Conclusions. These data provide some evidence for an increase in preterm birth among women who report experiences of racism, particularly women with lower levels of education.