Income Inequality Fuels Worsening Birth Outcomes

The gap in birth outcomes between low-income and higher-income families is not only persistent but, in the case of low birth weight, is actually widening, according to a longitudinal study published today in JAMA Pediatrics.¹

The American health care system has long grappled with a persistent and troubling paradox: despite significant technological advancements and rising expenditures, maternal and infant health outcomes remain fractured along socioeconomic lines. These disparities represent more than just a social concern; they are a clinical and financial crisis, the study’s authors explain.

“Despite ongoing efforts to improve maternal and infant health,” they write, “socioeconomic disparities threaten to undermine population health gains and perpetuate cycles of disadvantage.”

They highlight that poverty levels are known to rise in conjunction with nutrition and medical costs around the time women give birth,² and yet, there is a lack of recent research on the relationship between poverty and birth outcomes.³ To better understand these trends, the researchers analyzed data from the Pregnancy Risk Assessment Monitoring System spanning 2012 to 2022, the most recent years for which data were available. This multistate surveillance system is unique because not only was it one of a kind, but it had been providing detailed information on the prenatal and postpartum periods before the CDC paused it indefinitely in March 2025.⁴

The study included a sample size of 380,499 individuals, making it one of the most comprehensive recent looks at birth outcome disparities in the US. Poverty status was defined according to an individual’s income being above or below 200% of the Federal Poverty Level (FPL).

A Decade of Growing Inequity

The key health indicators tracked were preterm birth, low birth weight, small/appropriate for gestational age, average gestational age in weeks, and birth weight in grams. By comparing these outcomes among women above and below the 200% FPL level, they hoped to identify whether modern macroeconomic conditions and health policies have successfully mitigated the risks associated with poverty. Overall, poverty status–related disparities were consistent over time.

More than a third of the study sample (n = 140,241) was living below 200% of the FPL, and more of them were younger vs those living above 200% of the FPL (87% vs 49% being younger than 30 years). They were also less likely to be White (49% vs 75%), a college graduate (11% vs 66%), and married (28% vs 80%). This sobering picture of maternal health in the US is further darkened by 1 metric in particular: individuals in the low-income group had worse overall birth outcomes compared with the high-income group. From 2012 to 2022, low birth weight jumped by 2.2 percentage points for the low-income group compared with 0.6 percentage points for the higher-income group:

• Low-income group: 7.2% to 9.4%
• Higher-income group: 5.7% to 6.3%

“This study found stark disparities in birth outcomes by poverty status, with inequities growing for low birth weight in recent years,” the authors wrote, indicating that for more vulnerable populations, the biological and environmental stressors of poverty are becoming increasingly difficult to overcome within the current health care framework.

Outcomes and Economics

These findings may serve as a call to action. Because socioeconomic adversity in the perinatal period can have “lasting effects for the mother and newborn,” the authors explain, including increased risks for cardiovascular disease and diminished adult health outcomes,^5,6 the initial cost of a poor birth outcome may merely be the tip of the iceberg. Addressing social determinants may no longer be sufficient. Traditional clinical interventions must begin to integrate economic support, as clinical care alone can no longer bridge the care gap created by systemic poverty.

“Antipoverty policies can provide needed resources to promote better maternal and child health,” the authors conclude, but they are not enough, and availability varies widely among the states. Stepped-up efforts need to include enhanced prenatal support, data-driven interventions, and policy advocacy.

Knowing that childhood circumstances often dictate adult health and adverse pregnancy outcomes may be precursors to future chronic diseases, they add that their results should serve as a warning, in that identifying these trends is only the first step toward finding “solutions to reverse growing maternal and infant health inequities.”

References

1. Dore EC, Reynolds MM, Collin DF, Hamad R. Trends in poverty and birth outcomes in the US. JAMA Pediatr. Published online March 2, 2026. doi:10.1001/jamapediatrics.2026.0004
2. Hamilton C, Sariscsany L, Waldfogel J, Wimer C. Experiences of poverty around the time of a birth: a research note. Demography. 2023;60(4):965-976. doi:10.1215/00703370-10837403
3. Lleras-Muney A, Schwandt H, Wherry L. Poverty and health. National Bureau of Economic Research. August 2024. August 2024. Accessed March 2, 2026. https://www.nber.org/papers/w32866
4. CDC suspends Pregnancy Risk Assessment Monitoring System (PRAMS) data collection. Arizona Public Health Association. March 11, 2025. Accessed March 2, 2026. https://azpha.org/2025/03/11/cdc-suspends-pregnancy-risk-assessment-monitoring-system-prams-data-collection/
5. Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol. 2018;41(2):239-246. doi:10.1002/clc.22887
6. Almond D, Currie J, Duque V. Childhood circumstances and adult outcomes: act II. J Econ Lit. 2018;56(4):1360-1446. doi:10.1257/jel.20171164