Abstract 14305: Experiences of Racism and Risk of Preeclampsia: Results From the Black Women’s Health Study

Abstract

Introduction: In the United States (US) Black women have higher rates of preeclampsia than White women, which contributes to cardiovascular disease disparities. Differences in traditional cardiometabolic risk factors do not fully explain this disparity, and there is growing consensus that experiences of racism may be a root cause. Few studies have evaluated associations between racism and preeclampsia, and none have done so among a cohort of exclusively Black women. Research Question: Are daily and institutional racism associated with preeclampsia among Black women? Methods: We analyzed data from the Black Women’s Health Study, a follow-up study of approximately 59,000 US Black women beginning in 1995. We included 5,315 women who were nulliparous at baseline and had their first pregnancy between 1995 and 2009. Racism was measured as a total daily racism score (reported as daily exposure to interpersonal racism) and an institutional racism score (reported as ever treated unfairly due to race with respect to police, housing, or job). We used unadjusted and adjusted (age at first birth, total gravidity, baseline education attainment, health insurance, smoking, alcohol use, and Body Mass Index) logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for preeclampsia in quartiles of daily racism and domains of institutional racism. A sensitivity analysis examined associations for women with only one birth. Results: Among 5,315 participants, 9.2% had preeclampsia. [BK1] Compared to women in the lowest quartile of exposure to daily racism, those in the highest quartile had 53% increased odds of preeclampsia (adjusted OR 1.53; 95% CI 1.14, 2.05). Compared to women with no history of institutional racism, the ORs for preeclampsia in women who experienced institutional racism in two or three domains were 1.37 (95% CI 1.04, 1.80) and 1.27 (95% CI 0.085,1.86), respectively. Results were similar among women with only one birth: compared to the lowest quartile, women in the highest quartile of daily racism had an 89% higher risk (adjusted OR 1.89; 95% CI 1.31, 2.75). Conclusion: Racism is associated with an increased risk of preeclampsia in US Black women and may contribute to their disproportionately high prevalence of preeclampsia.