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

• Published in: Maternal and child health journal 2024-05, Vol.28 (5), p.969-978
• Main Authors: Lee, Kiara, Pellowski, Jennifer A., Brayboy, Lynae M., Thompson, Kathryn D., Dunsiger, Shira
• Format: Article
• Language: English
• Subjects: Black white relations; Discrimination; Disorders; Gynecology; Health disparities; Health services; Health surveillance; Hypertension; Maternal and Child Health; Maternal mortality; Medicine; Medicine & Public Health; Morbidity; Mortality; Mothers; Pediatrics; Population Economics; Pregnancy; Pregnancy complications; Public Health; Racial differences; Racial inequality; Racism; Regression analysis; Risk assessment; Sociology; Statistics; Systemic racism
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-023-03885-0

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. Significance What is Already Known? Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal mortality in the United States are well-documented. What this Study Adds? The role of racism and/or discrimination in affecting one’s risk of developing a hypertensive disorder of pregnancy is not well-studied. Non-Hispanic and Hispanic Black individuals did not have statistically significantly higher odds of having hypertension during pregnancy compared to non-Hispanic White individuals, when experiences with racism and/or