Abstract 17351: Structural Racism and 3-month Postpartum Blood Pressure in a Mulitethnic Prospective Cohort

Abstract

Introduction: Postpartum hypertension is a leading cause of racial inequities in maternal morbidity and mortality. Research Question: Is racial-economic segregation, a proxy for structural racism, associated with differences in postpartum blood pressure (BP) in Black, Hispanic and Asian (“Global Majority”) birthing people? Methods: We used data (n=369) from the coronaVirus Impact on Birth Equity (VIBE) Study, a prospective cohort in Philadelphia and New York City, 2022-2023. We measured racial-economic segregation by the Index of the Concentration of Extremes (ICE) using zipcode. Participants completed the Gendered Racial Microagressions (GRM) in Obstetrics Scale, and reported postpartum BPs through a text-messaging platform for 90 days. We used mixed-effects linear regression with repeated measures to estimate associations between ICE and postpartum systolic and diastolic BP (SBP, DBP). We adjusted for prepregnancy BMI, race-ethnicity, age, parity, and prepregnancy hypertension. We tested effect modification by hypertensive disorders of pregnancy (HDP) and GRM. Results: Participants were 10.3% Asian, 38.0% non-Hispanic Black, 38.2% Hispanic, and 13.6% other; 26.0% had HDP, 70.7% lived in high concentration poor, Black neighborhoods (highest quartile of ICE), and 37.6% experienced GRM. People in poor, Black neighborhoods had a higher 90-day postpartum mean SBP (120.6 mmHg) than those in other neighborhoods (116.4 mmHg, difference (β)=4.2, 95% confidence interval(CI)=1.7, 6.8; adjusted difference (aβ) = 2.1, 95% CI=0, 4.2). DBP did not differ (73.8 vs. 73.1 mmHg, β =0.8, 95%CI=-1.1, 2.6; aβ=0.1, 95% CI=-1.9, 1.6). Associations did not vary by HDP but were heightened for participants in poor, Black neighborhoods who experienced GRM vs. those in other neighborhoods who did not experience GRM (SBP: β = 6.2, 95%CI= 2.8, 9.6; aβ = 4.2, 95%CI = 1.3, 7.1; DBP: β = 2.1, 95%CI= 0.5, 4.7; aβ = 1.1, 95%CI = -1.3, 3.6). Conclusions: Racial-economic segregation is associated with higher postpartum BP over a 90-day period in Global Majority people, and further heightened in those who experienced GRM. Interventions to disrupt structural racism, including segregation, and eliminate GRM in obstetric care may improve postpartum health inequities.