Reconsidering Risk: Racial Differences in Maternal Health and Low Birth Weight Among College-Educated Black and White Women

Background and Purpose:

The black infant mortality rate is two times the rate for white infants in the United States. Although infant mortality is on the decline in the United States, racial disparities persist. Infants born preterm (<37 weeks) and at low birth weight (LBW) (<2500grams) account for the majority of infant deaths experienced by black women. Study finding suggests that the black-white infant mortality racial disparity widens with increased maternal education. Limited studies have focused on racial differences in the maternal health and birth outcomes of college-educated women. This study uses national data to examine whether rates of preconception health conditions, pregnancy-induced health conditions, and low birth weight differ among black and white college-educated women.  

Methods:

Data from the 2016 Natality files of all births in the United States was used for this study. U.S. born non-Hispanic college-educated black (N=61,672) and white (N=732,905) women are the comparison groups in the study. Foreign-born mothers, infants born with congenital anomalies, multiple births, and less than 20-week gestation births were excluded from the sample. To determine racial differences in maternal chronic health conditions, Chi-square analyses were conducted separately for each preconception and pregnancy-induced condition (diabetes and hypertension). Logistic regression was completed to determine racial differences between college-educated women and preconception/pregnancy-induced chronic health conditions to LBW infants.   

Results:

In this sample, 9.59% of black women had a LBW infant compare to 3.69% of white women. The results indicated that all racial comparisons for maternal chronic health conditions between black and white women were significant. Black women were more likely to have preconception diabetes (X²=504.26,df=1,p<.001) compare to white women. Black women were more likely to have pregnancy-induced diabetes (X²=106.35,df=1,p<.001) compare to white women. Black women were more likely to have preconception hypertension (X²=2.80,df=1,p<.001) compared to white women. Lastly, black women were more likely to have pregnancy-induced hypertension (X²=360.10,df=1,p<.001) compare to white women. The logistic regression indicated that black women were (OR=2.56) more likely to have a LBW infant than white women. There was a significant difference between black and white women in preconception diabetes, preconception hypertensive disorder, and pregnancy-induced hypertensive disorder on LBW. Moreover, black women were more likely to have maternal health conditions associated with LBW infants.   

Conclusions and Implications:

Social workers are in hospitals, community centers, and non-profit agencies, which puts social workers in a position to improve maternal and infant health outcomes. Moreover, social work practitioners need to understand the intersection of race, class, and gender when working with black women and infants in these settings. The well-being of families is a primary focus of social work research and practice; therefore, social work scholars should develop a research agenda focused on improving these health outcomes. Research and interventions based on social work values and ethics are imperative in eliminating maternal and infant health disparities.