Preterm Birth in Black Birthing People: A Systematic Literature Review and Meta-Analysis

Background: Preterm birth (PTB) is a global health challenge with significant morbidity and mortality rates among affected infants driven by various factors. In Canada, approximately 8% of babies are born prematurely, contributing to infant mortality, and imposing social and financial burdens on families and society. Racial disparities in PTB are evident, particularly within Black populations in the United States, with limited data available in Canada. Our objective was to understand the epidemiology, risk factors, and racial disparities related to PTB in this population. Methods: This review was conducted in English using a combination of search terms "preterm birth", "Black women" and "Canada" in various online databases. Included and excluded articles were confirmed by each reviewer and organized using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The quality assessment was conducted using the Newcastle-Ottawa Scale. A multi-level meta-analysis was performed to account for inter-study correlations, focusing on three primary birth outcomes: PTB, low birth weight (LBW), and small for gestational age (SGA). Results: Over 1,000 studies were screened, 10 articles in the review, and nine in the meta-analysis. The articles discussed how the Black population experienced higher rates of PTB and other adverse pregnancy outcomes including LBW, SGA, and stillbirth. The articles also addressed the relationship between PTB and socioeconomic risk factors such as level of education, income, poverty, and social isolation. The results of the multi-level meta-analysis indicated that the associations between maternal race/ethnicity and PTB (and between maternal race/ethnicity and SGA) were the only associations found to be significant across the studies. Conclusions: Despite Canada's universal healthcare system, Black birthing people face significant disparities in maternal health, underscored by negative healthcare experiences and systemic racism within the healthcare system. Addressing these disparities requires comprehensive approaches including race-based data collection, policy advocacy, and healthcare system reforms to ensure equitable access to care and improve maternal and neonatal health outcomes. J Clin Gynecol Obstet. 2024;13(3):59-74 doi: https://doi.org/10.14740/jcgo985