In a groundbreaking study poised to reshape our understanding of perinatal health disparities, researchers have delved deep into the complex intersection of clinical risk factors with adverse birth outcomes among Black women born in the United States and Africa. This research addresses two critical and interrelated perinatal complications: preterm birth (PTB) and small for gestational age (SGA) deliveries, shedding new light on how the origins of Black women can influence these outcomes. Utilizing robust data from California—the most populous and ethnically diverse state in the nation—the study unearths significant differences that transcend simple socioeconomic or demographic explanations, pointing toward intrinsic and environmental factors intertwined with maternal origins.
Preterm birth, defined as delivery before 37 weeks of gestation, represents a leading cause of neonatal morbidity and mortality worldwide. Meanwhile, small for gestational age infants—those whose birth weight is below the 10th percentile for their gestational age—face elevated risks for both short-term complications and lifelong adverse health trajectories. Previous investigations have consistently revealed that Black women in the United States experience disproportionately higher rates of both PTB and SGA compared to other racial and ethnic groups. However, the novel aspect of this research lies in parsing the heterogeneity within Black populations, distinguishing between U.S.-born Black women and their African-born counterparts.
The research team, led by McKenzie-Sampson and colleagues, meticulously examined clinical risk profiles among these populations to identify which factors associate most strongly with PTB and SGA. Employing sophisticated statistical models, the study adjusts for confounders such as maternal age, parity, prenatal care utilization, and pre-existing medical conditions like hypertension and diabetes. This comprehensive approach ensures an accurate delineation of risk, avoiding misleading conclusions that have plagued prior studies by failing to account for demographic nuances.
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One of the study’s most striking revelations is the variable impact of clinical risk factors depending on maternal nativity. While U.S.-born Black women exhibited a relatively elevated prevalence of established risk factors such as chronic hypertension and obesity, African-born Black women often presented with differing profiles—sometimes marked by fewer traditional risk factors but higher susceptibility to adverse outcomes nonetheless. This counterintuitive finding raises probing questions about the complex interplay of genetics, environmental exposures, and psychosocial stressors that evolve distinctly across diasporic experiences.
The research further emphasizes that African-born Black women, despite generally having better baseline health metrics, are not impervious to elevated PTB and SGA risks. The stress of acculturation, potential barriers to healthcare access, and systemic biases potentially contribute to divergences in birth outcomes from the U.S.-born subgroup. These maternal origins intricately connect with the social determinants of health—a multidimensional matrix including neighborhood segregation, exposure to structural racism, economic insecurity, and healthcare disparities—that exert powerful effects beyond traditional clinical metrics.
Importantly, the study’s deep dive into gestational age and fetal growth distributions underscores the necessity of nuanced clinical screening. Standard risk assessment tools developed predominantly in homogeneous populations may inadequately capture the distinct trajectories of children born to diverse Black women, potentially leading to underdiagnosis or misclassification of at-risk pregnancies. Tailoring prenatal care strategies to reflect these differences could meaningfully reduce adverse outcomes and bridge persistent gaps in maternal-child health equity.
Moreover, the investigation advances our understanding of biological pathways implicated in PTB and SGA. Inflammatory markers, vascular function, and stress-induced hormonal changes emerge as critical mediators influenced variably by ancestry-related factors and lived experiences. Such mechanistic insights provide fertile ground for translational research targeting preventative interventions customized to the unique needs of these populations.
The findings hold profound implications for public health policy and clinical practice. Recognizing that Black women are not a monolithic group but rather shaped by diverse migration histories mandates a paradigm shift. Healthcare systems must integrate culturally sensitive approaches that accommodate the heterogeneity among Black populations, promoting culturally competent care and enhanced patient-provider communication. Fostering trust and reducing systemic barriers could mitigate the amplified risks identified in African-born Black women.
In addition to clinical risk factors, the study hints at the potential influence of epigenetic modifications triggered by environmental and psychosocial stressors unique to each subgroup. Though not exhaustively explored within this work, such molecular mechanisms offer a compelling avenue for future research that blends genetics with social science, embodying the emerging field of social epigenomics.
These insights also invigorate conversations surrounding maternal mental health as an underrecognized determinant of birth outcomes. Chronic stress, postpartum depression, and anxiety—which disproportionately affect marginalized communities—may synergistically amplify vulnerabilities to PTB and SGA. Integrating mental health screening into prenatal care, especially for Black women with varied cultural backgrounds, could be transformative.
The research also interrogates prenatal care disparities, observing that African-born women may encounter more substantial obstacles in navigating healthcare systems, influenced by language barriers, insurance coverage gaps, and implicit biases among providers. Streamlining access and delivering equitable care models are essential to counteract these impediments.
As the United States continues to grapple with persistent racial inequities in maternal and child health, this study contributes pivotal evidence advocating for intersectional frameworks that consider nativity alongside race, socioeconomic status, and neighborhood contexts. The nuanced understanding of how clinical risk factors manifest differently illuminates pathways toward personalized medicine and community-level interventions.
Crucially, these findings urge that biomedical investigations transcend reductive racial classifications, integrating global Black diasporic identities into research design and policy formulation. Acknowledging the heterogeneity embedded within racial groups enriches scientific rigor and fosters health outcomes that honor diversity.
The study’s methodological rigor—leveraging California’s expansive birth records linked to clinical data—provides a robust template for other states and countries seeking to unravel the complex tapestry of perinatal health disparities. It underscores the value of detailed, disaggregated data collection and the ethical imperative for research that supports vulnerable populations.
Overall, this pioneering research underscores the urgency of addressing the multifaceted challenges facing Black women and their infants in both the United States and globally. By illuminating the nuanced relationships between clinical risk factors, maternal origin, and adverse birth outcomes, it charts a path forward that marries scientific inquiry with social justice imperatives. The hope for the future lies in translating these insights into targeted interventions, policy reforms, and community engagement initiatives that transform perinatal care, striving for equity and excellence.
As we await continued exploration and subsequent validation studies, the present findings serve as a clarion call for healthcare providers, researchers, and policymakers alike. Addressing perinatal disparities requires embracing complexity, fostering collaboration, and prioritizing the voices and needs of diverse Black women. Only through such collective commitment can the promise of healthier beginnings be realized for every child, irrespective of maternal birthplace.
Subject of Research: Association between clinical risk factors for preterm birth and small for gestational age delivery among U.S.- and African-born Black women.
Article Title: Clinical risk factors and adverse perinatal outcomes among U.S. and African-born Black women in California.
Article References:
McKenzie-Sampson, S., Baer, R.J., Costello, J. et al. Clinical risk factors and adverse perinatal outcomes among U.S. and African-born Black women in California. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02361-7
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41372-025-02361-7
Tags: addressing disparities in maternal and infant healthCalifornia birth outcomes by ethnicityclinical risks during pregnancy in Black womenenvironmental factors affecting Black maternal healthethnic diversity in perinatal health studiesintersection of race and maternal healthmaternal origins and birth outcomesneonatal morbidity in Black infantsperinatal health disparities in Black womenpreterm birth risk factors in Black womensmall for gestational age birth outcomessocioeconomic influences on birth outcomes
