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. 2024 May;28(5):969-978.
doi: 10.1007/s10995-023-03885-0. Epub 2024 Feb 3.

The Association of Racism and Discrimination in Disparities of Hypertensive Disorders of Pregnancy in the United States: An Analysis of PRAMS Data

Kiara Lee  1 , Jennifer A Pellowski  2 , Lynae M Brayboy  3   4   5 , Kathryn D Thompson  6   7 , Shira Dunsiger  8
Affiliations

The Association of Racism and Discrimination in Disparities of Hypertensive Disorders of Pregnancy in the United States: An Analysis of PRAMS Data

Kiara Lee et al. Matern Child Health J. 2024 May.

Abstract

Background: Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal outcomes such as maternal mortality in the United States (US) are well-documented, but the relationship of racism and/or discrimination with one's risk of developing a hypertension during pregnancy (HDP) is not well-studied.

Methods: Data from 17 sites that asked questions regarding experiences with racism and/or discrimination during pregnancy via the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2020) was used. Logistic regression models were used compare the potential of stress induced HDP from perceived experiences of racism and/or discrimination versus the effect of systemic racism and/or discrimination (in healthcare settings and generally) on racial disparities in HDP diagnosis.

Results: Among 9,907 live births, 18% of participants reported they were diagnosed with hypertension during pregnancy, with non-Hispanic Black individuals having the highest rate (21.8%). Regarding experiences of racism and/or discrimination, 76.4% of participants responded "yes", with all races/ethnicities studied here except non-Hispanic White individuals responding "yes" at rates higher than 89%. Perceived experiences of racism and/or discrimination did not statistically significantly affect one's odds of being diagnosed with HDP (OR = 0.94, CI: 0.74, 1.20). The disparity in odds of having hypertension during pregnancy between Non-Hispanic Black individuals and non-Hispanic White individuals was not statistically significant when perceived experiences of racism and/or discrimination were included in the model.

Conclusions: Experiences of racism and/or discrimination drive racial disparities in hypertensive disorders in pregnancy.

Public health implications: It is vital to eliminate racist and discriminatory practices and behaviors to reduce maternal morbidity and mortality.

Keywords: Discrimination; Health equity; Hypertensive disorders of pregnancy; Intersectional discrimination; Maternal health; PRAMS; Racism.

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