{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T06:53:55Z","timestamp":1793516035734,"version":"4.5.0"},"reference-count":111,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005370","name":"Gates Cambridge","doi-asserted-by":"crossref","award":["OPP1144"],"award-info":[{"award-number":["OPP1144"]}],"id":[{"id":"10.13039\/501100005370","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2022,5,21]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2013Ottawa 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\u2019s \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test and I\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 13 597 retrieved records, 24 articles were included. Studies included cohort, case\u2013control 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2022-009227","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T20:00:48Z","timestamp":1659470448000},"page":"e009227","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":100,"title":["Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-9708","authenticated-orcid":false,"given":"Kim Robin","family":"van Daalen","sequence":"first","affiliation":[{"name":"Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeenan","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kebede","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Einstein College of Medicine, Bronx, New York City, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Cipriano","sequence":"additional","affiliation":[{"name":"Cayetano Heredia University, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Maimouni","sequence":"additional","affiliation":[{"name":"University of East Anglia, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekiomoado","family":"Olumese","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthea","family":"Chui","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isla","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Oliver-Williams","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,2]]},"reference":[{"key":"2025073014251199000_7.8.e009227.1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/0310057X20966606","article-title":"Anarcha, Betsey, Lucy, and the women whose names were not recorded: the legacy of J Marion Sims","volume":"48","author":"Cronin","year":"2020","journal-title":"Anaesth Intensive Care"},{"key":"2025073014251199000_7.8.e009227.2","doi-asserted-by":"crossref","first-page":"3282","DOI":"10.1007\/s43032-021-00567-6","article-title":"#SayHerName: should obstetrics and gynecology reckon with the legacy of JM Sims?","volume":"28","author":"Christmas","year":"2021","journal-title":"Reprod Sci"},{"key":"2025073014251199000_7.8.e009227.3","doi-asserted-by":"crossref","unstructured":"Jones JH . 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