Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Institute for Child & Family Well-Being, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
J Racial Ethn Health Disparities. 2024 Jun;11(3):1741-1753. doi: 10.1007/s40615-023-01647-w. Epub 2023 Jun 8.
Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.
几十年来，美国一直存在出生结果的种族和民族差异，尽管其原因仍未得到很好的理解。生命历程观点认为，黑人产妇的较差结果源于生命早期面临更多的压力源，以及随着时间的推移，面临更多的压力源。尽管这一观点很突出，但很少有实证研究对其进行调查。我们分析了来自威斯康星州低收入家庭的 1319 名接受围产期家访服务的妇女的纵向数据。进行了变量和个体中心分析，以评估 15 种不良儿童经历 (ACEs) 和 10 种不良成人经历 (AAEs) 是否单独和组合与西班牙裔（即拉丁裔）和非西班牙裔黑人和白人参与者的流产、早产和低出生体重有关。不出所料，早产和低出生体重存在差异，ACEs 和 AAEs 都与较差的妊娠和分娩结果有关。出乎意料的是，双变量和多变量分析表明，ACEs 和 AAEs 的相关影响对非西班牙裔白人妇女最为显著。潜在类别分析产生了四种生命历程逆境模式，多组潜在类别分析证实，与白人妇女相比，高逆境类别分配与西班牙裔妇女的影响不那么显著，而与黑人妇女的影响甚至更不显著。我们讨论了对矛盾发现的解释，包括人际和结构性种族主义等替代压力源可能更好地解释不成比例地影响黑人产妇的生殖差异的可能性。
