The association of racism and discrimination in disparities of hypertensive disorders of pregnancy: an analysis of PRAMS data

Abstract

Background: Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal mortality in the United States are well-documented, but the role of racism and/or discrimination in affecting one’s risk of developing a hypertensive disorder of pregnancy 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) from was used. Regression models were used to estimate odds of hypertensive disorder diagnosis in pregnancy using adjusted models controlling for cofounders: biological risk factors, socioeconomic factors, and experiences of racism and/or discrimination. Results: Among participants with live births (N = 69,751), 14.9% of participants stated they were diagnosed with hypertension during pregnancy with non-Hispanic and Hispanic Black individuals having the highest rates (19.8%). 13.1% of participants experienced racism and 15.6% of participants experienced discrimination. Experiencing racism or discrimination increased one’s odds of having hypertension during pregnancy by 1.14 times (CI: 1.00 - 1.31) and 1.30 times (CI: 1.02 - 1.65), respectively. When experiences with discrimination were included, non-Hispanic and Hispanic Black individuals did not have statistically significantly higher odds of having hypertension during pregnancy compared to non-Hispanic White individuals. 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 in healthcare to reduce maternal morbidity and mortality.

Social Determinants of Health as Primary Risk Factors of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

“…14 Lee et al pursued specific potential confounders of racism and discrimination, also including SES among their covariates. 15 Further, Bryant et al called for "a more sophisticated approach to further target explaining disparities and identifying targets for improvement." 12…”