Summary
This individual participant data meta-analysis of over 2.1 million pregnancies across 20 high-income and upper-middle-income countries found significant racial and ethnic disparities in perinatal outcomes. Babies born to Black women experienced substantially elevated risks of neonatal death (2-fold), stillbirth (2.16-fold), preterm birth (1.65-fold), and small-for-gestational-age status (1.39-fold) compared with babies born to White women, after adjustment for key maternal and sociodemographic confounders. The findings suggest that structural and systemic factors beyond individual risk factors may contribute to persistent disparities in pregnancy outcomes.
Regional applicability
These findings are directly applicable to UK maternity services, which serve diverse racial and ethnic populations with documented disparities in maternal and perinatal outcomes. The data inform UK policy discussions on reducing inequalities in maternity care and highlight the need for investigation of mechanisms underlying these disparities in the UK health system context.
Key measures
Odds ratios (95% confidence intervals) for neonatal death, stillbirth, preterm birth, and small-for-gestational-age status by maternal race/ethnicity category (White, Black, South Asian, Hispanic, Other), adjusted for maternal age, BMI, parity, and education level
Outcomes reported
The study assessed the association between maternal race/ethnicity and perinatal outcomes including neonatal mortality, stillbirth, preterm birth, and small-for-gestational-age births. Data were analysed from 2,198,655 pregnancies across 51 studies in 20 high-income and upper-middle-income countries.
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