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AAP Grand Rounds 13:50-51 (2005)
© 2005 American Academy of Pediatrics
| The first 20% of the full text of this article appears below. |
African American infants are more than twice as likely to die in the first year of life as white infants. 1 Very low birthweight (VLBW) infants (<1500g) make up 1% of all births, and account for at least half of all neonatal deaths and 63% of the black-white disparity in infant mortality in the United States.2 African American women deliver VLBW babies at a rate 3 times greater than white women. Paradoxically, the racial disparity in VLBW not only persists but increases as sociodemographic risk factors (eg, education) decrease.3 Studies of differences among racial groups of proximal causes of VLBW (eg, maternal age, smoking, substance abuse, infection) have failed to adequately explain the black-white disparity in VLBW.4
Previous investigators have postulated that chronic stress, such as that caused by the personal experience of racial discrimination or bias, adversely affects African American women and leads to worse birth outcomes.5,6 The experience of racism, like other stress factors, produces predictable and measurable physiologic responses, such as tachycardia and hypertension. The results of prior studies have suggested that the chronic stress of being victimized by racism underlies more proximal causes of adverse birth outcome (eg, smoking, hypertension).7
For the current study, researchers from
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