Prenatal Racial Discrimination, Maternal Depressive Symptoms, Birth Outcomes, and Infant Development in African American Families

Background/Purpose. Perceived discrimination during pregnancy has been linked to postpartum depression, particularly for African American women at higher socioeconomic risk (Stepanikova & Kukla, 2017). These factors may be related to increased rates of adverse birth outcomes for African American infants (Martin et al., 2018). Other research has suggested that maternal experience of discrimination may affect infant developmental outcomes (Rosenthal et al., 2018). The aim of the current study was to examine relations among maternal perceived discrimination during pregnancy, maternal pre- and post-natal depressive symptoms, adverse birth outcomes, and infant development among low-income African Americans, and the moderating role of socioeconomic risk.

Methods. Participants were 118 African American pregnant women recruited from metropolitan Early Head Start and WIC programs. On average, mothers were 25 years old and had monthly incomes of $1,640. The majority had a high school diploma or beyond (92%) and was single (62%). Mothers were interviewed in their homes during the third trimester and again 4-6 months postpartum, with a phone interview 4 weeks after delivery. Maternal measures included the Everyday Discrimination Scale (Williams et al., 1997), the Edinburgh Antenatal/Postnatal Depression Scale (Cox et al., 1987), the Health Practices Questionnaire (Lindgren, 2006), and a questionnaire regarding birth outcomes. Infants were assessed at aged 4-6 months using the Bayley Scales of Infant Development (Bayley, 2005). Cumulative socioeconomic risk was a composite of three dichotomized risks: low education (< HS); single parent; and low-income (annual income < $10,000).

Results. Controlling for maternal age, SES risk and prenatal health practices, prenatal discrimination significantly predicted postnatal depressive symptoms (β = .26, p = .01). After adjusting for prenatal depressive symptoms, the effect of prenatal discrimination was not significant. SES risk significantly moderated the effect of prenatal discrimination on postnatal depressive symptoms (β = .17, p = .03); higher prenatal discrimination was related to increased postnatal depressive symptoms for mothers with greater SES risk (simple slope test at 1 SD above the sample mean: β = .18, p = .03). Logistic analyses, controlling for maternal age, SES risk, and prenatal health practices, revealed that prenatal discrimination significantly predicted adverse birth outcomes (Odds Ratio = 1.003, 95% CI: 1.00, 1.01). Regression analyses, controlling for maternal age, SES risk, prenatal health practices, and prenatal depressive symptoms, suggested that prenatal discrimination significantly predicted infant cognitive raw scores (β = -.25, p = .02) and gross motor raw scores (β = -.26, p = .02).

Conclusions/Implications. Overall, the findings of this study suggest that, among African American families, prenatal discrimination has an impact on birth outcomes, infant development, and postnatal depression for mothers at higher socioeconomic risk. Social work practice should address discrimination in interventions for pregnant and post-partum African American women, and how it affects their mental health and the outcomes for their children.