Blood Pressure Ticks Up With Microaggressions During Pregnancy

Researchers drew ties between microaggressions experienced during obstetric care and higher postpartum blood pressures (BPs) based on a study on Asian, Black, and Hispanic women.

In a prospective postpartum cohort recruited before hospital discharge in 2022, the 37.5% of participants who said they experienced at least one “gendered racial microaggression” (GRM) during care trended toward modestly higher systolic BPs at days 1-10 (+1.88 mm Hg, 95% CI -0.19 to 3.95) and days 11-85 (+2.19 mm Hg, 95% CI 0.17-4.22) compared with peers not reporting these microaggressions.

In those participants with and without hypertensive disorders of pregnancy (HDP), the strongest increase in postpartum systolic BP was produced by the combination of GRM and living in a neighborhood strongly affected by structural racism (+7.55 mm Hg, 95% CI 3.41-11.69) compared with those who experienced neither, reported a group led by Teresa Janevic, PhD, MPH, epidemiologist at the Columbia University Mailman School of Public Health in New York City, in Hypertension.

“Our findings build on increasing evidence of the influence of racism on maternal outcomes. Experiences of racial-ethnic discrimination during obstetric care have been well documented in qualitative research … including feeling unheard, being ignored, and lack of shared decision making,” the investigators wrote.

Associations for diastolic BP were of smaller magnitude but followed a similar pattern. Though small, the single-digit excesses in BP should not be disregarded for these young people, Janevic’s team argued.

“This work serves as a reminder of the long-term impact that racism can have on one’s overall health. The magnitude of these types of physiologic changes may become cumulative over time and lead to the inequities we see in many health outcomes,” said study co-author Lisa Levine, MD, MSCE, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, in a press release from the American Heart Association.

The researchers defined GRMs as a type of interpersonal racism resulting from beliefs or prejudices based on the person’s race and gender and are subtle, daily, and unintentional racial slights committed against members of racialized groups. In contrast, structural racism reflects the oppressions shaping neighborhoods and institutions and leading to differential access to opportunity and resources.

If the association between personal microaggressions in obstetric care and high postpartum BP strengthens over time, as suggested by the results, one implication would be an opportunity for closer BP monitoring during this later postpartum window.

This summer, another study had shown that most people with new-onset HDP had persistent hypertension postpartum after hospital discharge — and these individuals tended to have more hospital readmissions and emergency department visits within 6 weeks.

“Clinicians and health systems can thus design postpartum interventions extending later into the postpartum [period], when BP may continue to be sensitive to social determinants of health such as GRM,” suggested Janevic and colleagues.

“Our findings provide further evidence that healthcare professionals and policies should focus more intensely on improving maternal healthcare equity,” Janevic stressed in a statement. “We need high blood pressure monitoring and interventions to extend further into the period after birth when blood pressure may continue to be sensitive to social drivers of health as well as racial microaggressions.”

The study recruited 373 self-identified Asian (10.5% of the cohort), Black (38.6%), and Hispanic (40.0%) people delivering at four hospitals in Philadelphia and New York City. The 373 study participants were about 53% foreign-born and were most commonly age 20-29 years (42.9%). Those with an HDP included 4.6% with chronic hypertension, 20.9% with pregnancy hypertension, and 13.4% with preeclampsia.

At study enrollment, participants were taught how to use an Omron BP monitor that would be taken home. They got regular text messages in English or Spanish asking for BP measurements spanning 3 months.

Study authors evaluated experiences of microaggression using the Gendered Racial Microaggressions Scale. Example items on the scale include: “I have been disrespected,” “someone told me to calm down,” and “someone accused me of being angry when speaking assertively.”

Analyses were adjusted for neighborhood-level structural racism using the Structural Racism Effect Index.

Participants were compensated up to a total of $100 in electronic gift cards for completing all research activities within the 3-month study period. Of the entire cohort, 18.5% did not report BP results after 6 weeks.

Janevic’s group acknowledged that the study design did not account for high prepregnancy BPs and unmeasured confounders such as diet.

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