Adverse birth outcomes and intergenerational exposure to multiple dimensions of structural racism among Black families in the U.S. South.

In cross-sectional studies from the United States, single indicators of structural racism have been associated with adverse birth outcomes. Yet little is known about multidimensional measures of structural racism and birth outcomes, or about the impact of such measurement across generations. We constructed a multidimensional measure of structural racism and linked it to a multigenerational birth outcomes dataset of Black women from South Carolina who gave birth between 1989 and 2020. Each family tree had information on grandmothers' (Generation 1, G1) and mothers' (Generation 2, G2) structural racism measures and mothers' (G2) and infants' (Generation 3, G3) birth outcomes (N = 37,544 family trees). We used confirmatory factor analysis to create four latent dimensions of structural racism: Criminal Justice, Economic Opportunity, Educational Resources, and Residential Segregation and Housing. We used multilevel logistic regression to examine the relationship between grandmothers' (G1) exposure to the four dimensions and mothers' (G2) and infants' (G3) preterm birth and low birthweight, and the relationship between mothers' exposure to the four dimensions and the infants' preterm birth and low birthweight. When both grandmothers' and mothers' exposures were accounted for in the same model, we found that greater exposure to structural racism in the Residential Segregation and Housing dimension among grandmothers was associated with a higher odds of poor birth outcomes for infants, while more exposure to structural racism in the Criminal Justice dimension was associated with better birth outcomes for infants. Mothers' structural racism exposure had no statistically significant association with their infants' birth outcomes in these models. This study highlights the importance of grandmothers' exposure to structural racism on infants' birth outcomes.