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Resilience During Pregnancy by Race, Ethnicity and Nativity: Evidence of a Hispanic Immigrant Advantage

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Abstract

The similar socioeconomic position of black and Hispanic women coupled with better birth outcomes among Hispanic women is termed the “Hispanic Paradox.” However, birth outcome disparities among Hispanic women exist by maternal nativity. Persistent unequal exposure over time to stressors contributes to these disparities. We hypothesized that variation in maternal resilience to stressors also exists by race, ethnicity, and nativity. We utilized data from the Spontaneous Prematurity and Epigenetics of the Cervix study in Boston, MA (n = 771) where resilience was measured mid-pregnancy using the Connor Davidson Resilience Scale 25. We assessed resilience differences by race/ethnicity, by nativity then by race, ethnicity, and nativity together. We also assessed the risk of low resilience among foreign-born women by region of origin. We used Poisson regression to calculate risk ratios for low resilience, adjusting for maternal age, education, and insurance. Resilience did not differ significantly across race/ethnicity or by foreign-born status in the overall cohort. US-born Hispanic women were more likely to be in the low resilience tertile compared with their foreign-born Hispanic counterparts (adjusted RR 3.52, 95% CI 1.18–10.49). Foreign-born Hispanic women also had the lowest risk of being in the low resilience tertile compared with US-born non-Hispanic white women (aRR 0.33, 95% CI 0.11–0.98). Resilience did not differ significantly among immigrant women by continent of birth. Overall, foreign-born Hispanic women appear to possess a resilience advantage. Given that this group often exhibits the lowest rates of adverse birth outcomes, our findings suggest a deeper exploration of resilience among immigrant Hispanic women.

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Data Availability

The fully de-identified data used for this analysis is available upon request for replication of results.

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Code Availability

The code used for the analyses in this paper is available upon request.

Funding

The funding for this work came from the Charles H. Hood Foundation. This work was also conducted with support from Harvard Catalyst-The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102), NIH/NIEHS K23ES02224204, and P30ES000002. Additional support came from the Chrissy and Jesse Brown Family and the Department of Pediatrics at the Children’s Hospital of Philadelphia.

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Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 19th Floor, Suite 19361, Philadelphia, PA, 19146, USA

    Diana Montoya-Williams, Rachel Ledyard & Heather H. Burris

  2. Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, KS3, Boston, MA, 02215, USA

    Michele R. Hacker

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  1. Diana Montoya-Williams
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Using their own language, all authors whose names appear on the submission:

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Correspondence to Diana Montoya-Williams.

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Montoya-Williams, D., Ledyard, R., Hacker, M.R. et al. Resilience During Pregnancy by Race, Ethnicity and Nativity: Evidence of a Hispanic Immigrant Advantage. J. Racial and Ethnic Health Disparities 8, 892–900 (2021). https://doi.org/10.1007/s40615-020-00847-y

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