Linking Adverse Experiences to Pregnancy and Birth Outcomes: A Life Course Analysis of Racial and Ethnic Disparities Among Low-Income Women

Joshua P. Mersky, Noelene K. Jeffers, Chien Ti Plummer Lee, Rebecca J. Shlafer, Dylan B. Jackson, Anthony Gómez

Research output: Contribution to journalArticlepeer-review


Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.

Original languageEnglish (US)
Pages (from-to)1741-1753
Number of pages13
JournalJournal of Racial and Ethnic Health Disparities
Issue number3
StatePublished - Jun 2024

Bibliographical note

Publisher Copyright:
© W. Montague Cobb-NMA Health Institute 2023.


  • Adverse childhood experiences
  • Birth outcomes
  • Disparities
  • Ethnicity
  • Life course
  • Race

PubMed: MeSH publication types

  • Journal Article


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