Maternal Race and Socioeconomic Status as Determinants of Neurodevelopment, Feeding, and Growth Outcomes in Preterm Infants: A Systematic Review

Abstract

Preterm birth remains one of the leading causes of neonatal morbidity and mortality worldwide and is associated with substantial risks of impaired neurodevelopment, feeding difficulties, growth restriction, and long-term disability. Although advances in neonatal intensive care have significantly improved survival among preterm infants, disparities in health outcomes persist across different racial and socioeconomic groups. Maternal race and socioeconomic status (SES) have emerged as important social determinants of neonatal health, influencing access to prenatal care, maternal nutrition, pregnancy complications, quality of neonatal intensive care, breastfeeding practices, developmental follow-up, and family support. These determinants affect not only immediate neonatal outcomes but also cognitive, motor, behavioral, nutritional, and physical development throughout infancy and childhood. This systematic review synthesizes current evidence regarding the influence of maternal race and socioeconomic status on neurodevelopmental, feeding, and growth outcomes among preterm infants. A systematic literature search was conducted using PubMed, Scopus, CINAHL, Web of Science, Embase, and Google Scholar for studies published between January 2015 and March 2025. Eligible studies included cohort studies, case-control studies, randomized controlled trials, longitudinal investigations, and systematic reviews evaluating associations between maternal social determinants and developmental outcomes in preterm infants. Evidence indicates that socioeconomic disadvantage is consistently associated with poorer cognitive performance, delayed language development, impaired executive functioning, lower breastfeeding rates, suboptimal nutrition, slower catch-up growth, and reduced access to developmental interventions. Racial disparities are strongly influenced by structural inequities, healthcare accessibility, maternal stress, discrimination, environmental exposures, and differences in post-discharge support rather than intrinsic biological differences. Early developmental interventions, family centered neonatal care, lactation support, culturally responsive healthcare, and comprehensive follow-up programs substantially improve developmental trajectories. These findings emphasize that addressing health inequities is essential for optimizing outcomes among preterm infants. Neonatal nurses play a pivotal role in identifying social risk factors, supporting families, promoting equitable care, and coordinating multidisciplinary interventions that improve neurodevelopment, feeding success, and growth.