Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
BMJ Glob Health. 2022 Aug;7(8). doi: 10.1136/bmjgh-2022-009227.
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.
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 test and I statistic.
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.
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.
种族歧视一直与各种健康结果和健康差异相关联，包括将种族歧视与不良妊娠结局的种族差异模式相关联的研究。为了扩大我们的知识，本系统评价和荟萃分析评估了所有关于自我报告的种族歧视与不良妊娠结局之间关联的现有证据。
无语言和时间限制地搜索了 8 个电子数据库，截至 2022 年 1 月。使用预编程的提取工具提取数据。使用纽卡斯尔-渥太华量表（NOS）对质量进行评估，并使用推荐评估、制定与评估分级（GRADE）方法对所有纳入的研究进行评估。对早产和小于胎龄儿进行随机效应荟萃分析。使用 Cochran's χ 检验和 I 统计评估异质性。
在 13597 条检索记录中，有 24 篇文章被纳入。研究包括队列、病例对照和横断面设计，主要在美国进行（n=20）。在所有结局中，报告了显著的正相关（经历种族歧视与不良妊娠事件之间）和非显著的相关（呈正相关趋势），没有研究报告显著的负相关。早产的总体汇总优势比（OR）为 1.40（95%CI 1.17 至 1.68；13 项研究），小于胎龄儿的 OR 为 1.23（95%CI 0.76 至 1.99；3 项研究）。当排除低质量研究时，早产 OR 减弱至 1.31（95%CI 1.08 至 1.59；10 项研究）。敏感性和亚组分析得到了类似的结果，表明存在显著的正相关。
这些结果表明，种族歧视对妊娠结局有不良影响。这得到了种族歧视作为不良健康结果的风险因素的更广泛文献的支持。为了进一步探索这种关联和潜在机制，包括中介和调节因素，需要来自大型人种多样化队列的更高质量证据。
