Ethnic, Nativity and Country of Origin Inequities in Preterm Birth Among Hispanic and Non-Hispanic Whites in New York City: What's Stress Got to Do With It?

Hispanic populations experience good birth outcomes despite their socioeconomic disadvantage, a phenomenon referred to as the Hispanic paradox. This health advantage, however, deteriorates over time and understanding of this pattern is limited. Using data from the 2009-2013 New York City (NYC) PRAMS survey linked with birth certificate data, we tested whether stressful life events (SLEs) partially accounted for differences in preterm birth (PTB) between birthing parents across ethnicity, nativity and country of foreign birth (CFB). Experiencing 3+ SLEs in the prenatal period was associated with increased odds of PTB (OR = 1.49, 95% CI 1.13, 1.97). However, stressors were not associated with greater risk of PTB among US-born Hispanic participants, or differences across CFB. SLEs are associated with increased odds of PTB after a threshold of 3+, but do not explain greater PTB among US-born, or some Hispanic subgroups, despite differences in SLEs across ethnicity and CFB among Hispanic birthing parents.

The Time has Come for All States to Measure Racial Discrimination: A Call to Action for the Pregnancy Risk Assessment Monitoring System (PRAMS).

INTRODUCTION: Racial/ethnic inequities in preterm birth (PTB) are well documented. Most of this research has focused on maternal behavioral and socio-demographic characteristics. However, the full magnitude of the racial/ethnic gap remains inadequately understood. Studies now point to the role of racial discrimination in producing PTB inequities, but limitations exist, namely the use of a single, dichotomous item to measures discrimination and the limited generalizability of most studies which have been conducted in single cities or states. METHODS: In this commentary we briefly review extant research on explanations for racial/ethnic inequities in PTB, and the role of racial discrimination in producing the racial/ethnic gap in adverse birth outcomes such as PTB. RESULTS: The Pregnancy Risk Assessment Monitoring System (PRAMS), a state-level, population-based survey, annually collects data from 51 states and cities ("states") on maternal behaviors and experiences in the perinatal period. The questionnaire consists of mandatory "Core" questions, and optional "Standard" questions. Currently 22 states include a "Standard" question on discrimination; 29 do not. PRAMS offers a unique opportunity to systematically assess discrimination among a diverse, population-based sample across the US. DISCUSSION: We urge PRAMS to at least include the current measure of discrimination as a mandatory "Core" question. Ideally, PRAMS should include a validated discrimination scale as a "Core" question. The time has come to name and assess the impact of discrimination on adverse birth outcomes. PRAMS can play a vital role in helping to close the racial/ethnic gap in PTB.