Recent research indicates that encountering microaggressions related to gender and race during pregnancy and childbirth may be associated with elevated postpartum blood pressure.
The study, published Thursday in the American Heart Association journal Hypertension, found subtle, potentially unintentional slights directed at pregnant people – such as being told to calm down – during obstetric care were associated with higher maternal blood pressure after childbirth and beyond.
"It is well known that Black, Hispanic and South Asian women experience microaggressions during health care," Dr. Teresa Janevic, the study's lead author, said in a news release. Janevic is an associate professor of epidemiology at Columbia University Mailman School of Public Health in New York. "It is not as well known whether these microaggressions may have an association with higher blood pressure."
Following childbirth, women may experience an increased likelihood of developing high blood pressure, known as postpartum hypertension. Although this condition is uncommon, it can pose serious health risks and is associated with a greater chance of heart disease in the future. The risk is amplified for those who have encountered blood pressure complications during pregnancy, such as preeclampsia.
In a recent study, researchers modified the Gendered Racial Microaggressions Scale, a comprehensive 26-item survey categorized into four factors, to capture the experiences of pregnant women receiving obstetric care. A total of 373 participants, comprising Asian, Black, and Hispanic women aged 16 to 46, completed the surveys while giving birth at four different hospitals located in Philadelphia and New York City. To assess place-based structural racism, the researchers linked electronic medical records to specific census tracts and evaluated disparities in various community-level factors, including eviction rates, median home values, income, education, and employment.
Participants in the study received home blood pressure monitors and were instructed to send their blood pressure readings via text message twice daily for the initial 10 days after being discharged from the hospital post-delivery. Following this period, they were asked to report their readings twice a week from day 11 to day 90.
Over one-third of the participants indicated that they encountered at least one instance of race- and gender-based microaggressions during their obstetrical care. Among those who reported such experiences, the average blood pressure readings over a three-month period were slightly elevated compared to those who did not face any microaggressions.
The participants who reported experiencing microaggressions and resided in neighborhoods characterized by significant structural racism exhibited the highest blood pressure readings. In contrast, those living in areas with minimal structural racism and without experiences of microaggressions showed the lowest readings. The disparity in systolic blood pressure – the upper value – between these two groups was 7.55 mmHg, while the difference in diastolic blood pressure – the lower value – was 6.03 mmHg.
Janevic noted that the link between microaggressions and elevated blood pressure was most significant during the period from 12 days to three months after giving birth.
"This is a crucial time for addressing high blood pressure," she stated. "Our research highlights the need for health care providers and policies to prioritize enhancing equity in maternal health care. It's essential to expand high blood pressure monitoring and interventions into the postpartum period, as blood pressure can still be influenced by social determinants of health and racial microaggressions."
Dr. Lisa Levine, the lead author of the study, stated in a news release that the results "highlight the enduring effects that racism can exert on an individual's overall health." She serves as an associate professor in reproductive health at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
"The extent of these physiological changes can accumulate as time progresses, potentially resulting in the disparities observed in numerous health outcomes," stated Levine, who serves as the director of the Pregnancy and Heart Disease Program at the medical school and is the chief of the Maternal Fetal Medicine Division.
Dr. Natalie Cameron, a specialist in internal medicine and a preventive medicine instructor at Northwestern University Feinberg School of Medicine in Chicago, remarked that the combined impact of structural and interpersonal racism was "significant." Cameron did not participate in the study.
"In a news release, she stated that for numerous individuals, this could determine whether they require medication to lower their blood pressure."
Cameron stated, "These findings highlight the importance of managing hypertension through more than just medication." He added, "We must focus on developing strategies to mitigate gendered racial microaggressions within healthcare environments and examine how these factors influence postpartum blood pressure."
