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With respect, it’s not that ‘being Black’ is a risk factor for birth outcomes. Rather, *being racialized as Black* & the attendant stressors & cumulative disadvantages that make pregnancy & birth riskier.
We have to take care with this language. “Being Black is a risk factor” reinscribes race-as-biology, naturalizes the outcomes of a political system that undergirds profound inequities in where we live, work, play, our access to health care...
If ‘being Black’ was a predictor of PTB, LBW, maternal mortality... then why do Black immigrants have better birth outcomes than US-born Black parents?
When we talk about differences in birth outcomes among Black people by natality or immigration status, we have to go back to the ‘cumulative disadvantages & stressors’ that come w/ being racialized as Black in the US across one’s lifecourse.
This is lifecourse epidemiology 101
Final thoughts: What do I mean by the "attendant stressors & cumulative disadvantages" of being racialized as Black?

I am referring to structural racism across the lifecourse, manifest in the spatialization of 'place'- where we live, learn, work, place.
- racial segregation via racial x class sorting (vestiges of redlining, restrictive covenants, & more recent subprime lending, which increased risk of foreclosure & re-entry into rental markets)
- urban health system facility locations often disadvantage US-born Black communities
- tying funding pf public edu to home values in a context where Black ownership is considered as 'devaluing' property has longitudinal effects on quality of edu resources & edu outcomes
- #EnvironmentalRacism social sorting in space = marginalized bear disproportionate exposures
I mention #EnvironmentalRacism because it is a considerable factor in birth outcomes:
- miscarriages (air pollution - associated w/ proximity to highway construction in historically Black n'hoods)
- preterm birth & low birth weight (lead, arsenic, ... in water, soil)
So, across the lifecourse, we 'accumulate' exposures to social+environmental stressors & toxins... which are mediated by class status (but not always- high SES Black women in wealthy, majority-white n'hoods disproportionately experience poor birth outcomes), education...
... and this is across the lifecourse (time) and scale (spatial, social/systemic- e.g. interpersonal vs. structural racism as manifest within health care settings.

But I'd emphasize that the disadvantages begin well before the first pre-natal appointment #ObstetricRacism
A bunch. Here's a sample. Across the studies I have reviewed, Black immigrants have similar birth outcomes to US-born whites. But there are not nearly enough studies on NCDs & birth outcomes among Black immigrants (inordinate focus on infectious disease)
FYI, one predictor of pregnancy- and birth-related morbidity is CVD. Here's a new paper finding that childhood experiences of racial discrimination are associated w/ higher CVD incidence in adulthood 👇🏾
Further, here's another recent paper on some of the facility-level factors contributing to pregnancy-related mortality from CVD:

"Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Cardiovascular Disease" sciencedirect.com/science/articl…
... and one more:

Dominguez (2011) Adverse Birth Outcomes in African American Women: The Social Context of Persistent Reproductive Disadvantage tandfonline.com/doi/full/10.10… (open access at the URL)

H/t @CescaCava
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