The Effect of Race-related Stress on Risk for Adverse Pregnancy Outcomes in Black Pregnant Persons Público
Williams, Sydni (Spring 2025)
Abstract
Low birth weight (LBW) and preterm birth (PTB) are significant contributors to infant mortality in the United States that disproportionally impact Black pregnant persons and their offspring. Although these outcomes have been linked to chronic stress, the contribution of race-related stress to these disparities remains largely understudied. We investigated the effect of race-related stress on weight and gestational age at birth in a prospective cohort of 192 pregnant Black persons recruited at Grady Memorial Hospital in Atlanta, Georgia. The Index of Race-Related Stress Brief (IRRS-Brief), sociodemographic characteristics, and blood cortisol levels were collected at study enrollment during the first trimester of pregnancy. Neonatal birth weights and gestational age were collected via standardized medical record abstraction. We conducted multiple regressions to determine whether greater race-related stress was associated with lower birth weight and gestational age while controlling for sociodemographic factors identified by DAG. We conducted Generalized Additive Models (GAM) to predict first-trimester cortisol using IRRS subscales. Race-related stress was not significantly associated with LBW or PTB and no significant predictors of the outcomes emerged from the regressions, including the interaction term between pediatric sex and IRRS. Significant non-linear associations were observed between institutional racism (p = 0.03, r² = 0.749) and cultural race-related stress (p = 0.02, r² = 0.931) and first-trimester cortisol levels, with education and income emerging as important predictors. These results suggest that race-related stress contributes to physiological stress responses, which may have downstream effects. Future studies are necessary to explore how race-related stress might contribute to these adverse birth outcomes. These studies should aim to better understand the relationship between race-related stress and cortisol and to inform their potential downstream impact on maternal and fetal health.
Table of Contents
Introduction
Materials and Methods
Results
Discussion & Conclusion
Acknowledgements
Grants
Disclosures
References
Figures
Figure 1: A conceptual model the gaps in knowledge
Figure 2: DAG of factors influencing relationship between race-related stress and birthweight
Figure 3: DAG of factors influencing relationship between race-related stress and gestational age
Figure 4: Boxplots depicting the distribution of race-related stress by gestational age
Figure 5: Box plots depicting the distribution of race-related stress by birthweight
Figure 6: Scatter plots of race-related stress vs. gestational age
Figure 7: Scatter plots of race-related stress vs. birth weight
Figure 8: Scatter plots of race-related stress vs. first-trimester cortisol levels
Tables
Table 1: Sociodemographic Characteristics of Study Participants by Low vs. Normal Birth Weight
Table 2: Bivariate correlations among IRRS variables, r (p-value)
Table 3: Regressions for outcome variables
Table 4: Summary of Generalized Additive Models
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