Abstract
This study aimed to estimate and compare racial inequality in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR) in two Brazilian birth cohorts. This was a cross-sectional study nested within two birth cohorts in Ribeirão Preto (RP) and São Luís (SL), whose mothers were interviewed from January to December 2010. In all, 7430 (RP) and 4995 (SL) mothers were interviewed. The maternal skin color was the exposure variable. Associations were adjusted for socioeconomic and biological covariates: maternal education, per capita family income, family economic classification, household head occupation, maternal age, parity, marital status, prenatal care, type of delivery, maternal pre-pregnancy BMI, hypertension, hypertension during pregnancy, and smoking during pregnancy collected from questionnaires applied at birth. Statistical analysis was done with the chi-squared test and logistic regression. In RP, newborns from mothers with black skin color had a higher risk of LBW and IUGR, even after adjusting for socioeconomic and biological variables (P<0.001). In SL, skin color was not a risk factor for LBW (P=0.859), PTB (P=0.220), and IUGR (P=0.062), before or after adjustment for socioeconomic and biological variables. The detection of racial inequality in these perinatal outcomes only in the RP cohort after adjustment for socioeconomic and biological factors may be reflecting the existence of racial discrimination in the RP society. In contrast, the greater miscegenation present in São Luís may be reflecting less racial discrimination of black and brown women in this city.
Highlights
The concept of race is a social construction, a product of history and culture and is not restricted to a biological or genetic meaning, as traditionally understood [1]
To estimate the effect of maternal skin color on the perinatal outcomes (LBW, preterm birth (PTB), and IURG) and to identify possible confounders, mediators, and colliders, we developed a theoretical model
In the Ribeirão Preto (RP) birth cohort, the percentage of low birth weight (LBW) was significantly higher among children born to mothers with black skin color (11.8%) compared to children born to mothers with brown (8.9%) or white skin color (7.2%) (Po0.001)
Summary
The concept of race is a social construction, a product of history and culture and is not restricted to a biological or genetic meaning, as traditionally understood [1]. By interacting with various social position markers, race can contribute to greater or lesser exposure to different health risks [2,3]. Extensive literature from the United States highlights race as an important predictor of health outcomes. Studies show that rates of low birth weight (LBW), preterm birth (PTB), and infant mortality are higher among children born to black mothers compared to those of white mothers [4,5,6,7,8]. Maternal factors typically explain one-third of those black-white differences [8]. In Brazil, these data are scarce and come from studies that do not use self-classification, which is considered the most recommended procedure [2,9,10,11]. The role of the racial component in generating and maintaining the very high levels of inequality in Brazilian society may be underestimated [2,10]
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