Associations Between Self-Reported Experiences of Discrimination, Socioeconomic and Racial Polarization, and Birth Outcomes in the Atlanta African American Maternal-Child Cohort

Background: Structural racism measures based on publicly available data alone do not capture the breadth of lived experiences of racism or their impacts. Few studies incorporate measures of lived experience in analyses of structural racism at the neighborhood level. We investigated associations between self-reported experiences of racism, measures of racialized economic segregation at the census tract level (a proxy for structural racism), and birth outcomes among pregnant African American people. Study Design: Participants were enrolled in the Atlanta African American Maternal-Child Cohort (N = 297). Experiences of racial and gender discrimination were measured during pregnancy using self-reported, validated questionnaires. The index of concentration at the extremes (ICE) was used to quantify economic segregation (ICEincome) and racialized economic segregation (ICErace-income) for the census tract of residence during pregnancy. An analysis of continuous ICE measures and self-reported experiences of discrimination was conducted using Kruskal-Wallis rank-sum testing. Linear regression was used to estimate associations between self-reported experiences of discrimination and ICE scores with gestational age (in weeks) at delivery and birthweight for gestational age z-scores. Results: Participants living in areas of higher racialized economic privilege reported more frequent experiences of discrimination (chi(2) ICEincome = 10.81; chi(2) ICErace+income = 6.30; p < 0.05). An increase in frequency of self-reported experiences of discrimination was associated with reduced gestational age at delivery (beta = -0.08, 95% confidence interval [CI] = -0.13, -0.03) but not with birthweight for gestational age in adjusted models. ICE scores were not associated with either birth outcome. Conclusions: In this Atlanta birth cohort, self-reported experiences of racial discrimination, but not measures of racialized economic polarization, were associated with reduced gestational age among African American pregnant people.