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

Abstract

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.