Abstract
Research suggests that exposure to racism partially explains why African American women are 2 to 3 times more likely to deliver low birth weight and preterm infants. However, the physiological pathways by which racism exerts these effects are unclear. This study examined how lifetime exposure to racism, in combination with maternal blood pressure changes during pregnancy, was associated with fetal growth. African American pregnant women (n = 39) reported exposure to childhood and adulthood racism in several life domains (e.g., at school, at work), which were experienced directly or indirectly, meaning vicariously experienced when someone close to them was treated unfairly. A research nurse measured maternal blood pressure at 18 to 20 and 30 to 32 weeks gestation. Standardized questionnaires and trained interviewers assessed maternal demographics. Neonatal length of gestation and birth weight data were collected from medical charts. Childhood racism interacted with diastolic blood pressure to predict birth weight. Specifically, women with two or more domains of indirect exposure to racism in childhood and increases in diastolic blood pressure between 18 and 32 weeks had lower gestational age adjusted birth weight than the other women. A similar pattern was found for direct exposure to racism in childhood. Increases in diastolic blood pressure between the second and third trimesters predicted lower birth weight, but only when racism exposure in childhood (direct or indirect) was relatively high. Understanding pregnant African American women's lifetime direct and indirect experiences with racism in combination with prenatal blood pressure may improve identification of highest risk subgroups within this population.
Highlights
This dysfunction may manifest in many ways, one of which would be as increased blood pressure attributable to increased vascular resistance, which can lead to a decrease in uteroplacental blood flow and placental perfusion, compromising fetal growth (Easterling et al, 1991; Easterling, Carr, Brateng, Diederichs, & Schmucker, 2001; Khong, De Wolf, Robertson, & Brosens, 1986; Misra, Hobel, & Sing, 2009; Valero De Bernabe et al, 2004)
Less than high school Some college Bachelor’s degree Graduate degree Domains of racism exposure Childhood personalb Childhood indirectb Adult personalb Adult indirectb Totalc Stressful life events Time 1 diastolic blood pressure (DBP) Time 2 DBP % Who increased in DBP Time 1 systolic blood pressure (SBP) Time 2 SBP % Who increased in SBP Birth weight (g) Length of gestation
DBP ϭ diabolic blood pressure; SBP ϭ systolic blood pressure. a Values reported are M (SD) unless otherwise noted. b Racism subscale scores could range from 0 to 4 domains. c Total racism was the sum of the subscales with a possible range from 0 to 16
Summary
Research suggests that exposure to racism partially explains why African American women are 2 to 3 times more likely to deliver low birth weight and preterm infants. Dominguez et al (2008) reported that for pregnant African American women, lifetime and childhood exposure to racism predicted lower fetal growth (birth weight adjusted for gestation length). It is likely that African American women with the highest lifetime exposure to racism have accumulated more physiological wear and tear over their lifetimes resulting in stress-response dysfunction During pregnancy, this dysfunction may manifest in many ways, one of which would be as increased blood pressure attributable to increased vascular resistance, which can lead to a decrease in uteroplacental blood flow and placental perfusion, compromising fetal growth (Easterling et al, 1991; Easterling, Carr, Brateng, Diederichs, & Schmucker, 2001; Khong, De Wolf, Robertson, & Brosens, 1986; Misra, Hobel, & Sing, 2009; Valero De Bernabe et al, 2004). We consider why DBP is implicated and SBP is not in the discussion
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