Descriptive Title: Advancing understanding of racism-related health disparities before birth
Project Summary/Abstract
Racial and ethnic injustice are prevalent and devastating causes of stress and subsequent health disparities.
Black and Latina women experience a higher burden of pregnancy complications, maternal mortality, and
preterm birth compared to White women. These disparities in birth outcomes are exacerbated by systems of
care that neglect or invalidate the experiences of pregnant women of color, contributing to high-risk deliveries,
unnecessary obstetric interventions, and death of women and infants. Yet, no studies have examined whether
experiences of racism prenatally affect fetal health and development through a process of “biological
embedding” of racism measured daily during pregnancy. This study will address three major gaps in the literature
to date. First, experiences of racism and discrimination are often measured globally, missing the cumulative
nature of stress exposure on fetal physiological development. Second, it is unclear whether specific partner
behaviors (e.g., validation of racism-related experiences) and/or culturally-grounded coping strategies grounded
in the Radical Healing Framework (e.g., racial/ethnic identity, activism) can buffer effects of racism on maternal
physiology, fetal physiology, and birth outcomes. Third, given the novelty of this research program, it is important
to integrate qualitative methods that center the experiences of Black and Latina women during this transformative
and vulnerable life stage. The objective of this proposal is to advance understanding of racism-related
health disparities in pregnant women and infants by (1) enrolling Black and Latina women during the 2nd and
3rd trimester of pregnancy and assessing daily racism experiences through daily diary assessments (14
consecutive days trimester); (2) measuring maternal and fetal psychophysiology during the third trimester (e.g.,
heart rate, heart rate variability); (3) assessing newborn neurodevelopment within 48 hours of birth; and (4)
exploring culturally-grounded buffers and qualitative experiences of racism on women and infants. We will enroll
400 pregnant women from the Atlanta, GA and Salt Lake City, UT metro areas (n=200/site), using established
protocols for recruiting and retaining women during this developmental stage. Participating women will complete
questionnaires and a 2-week daily diary of stressors related to racism in the 2nd and 3rd trimester. In the 3rd
trimester, women will complete these measures, a qualitative interview, and two weeks of in-home maternal and
fetal physiological measures, which includes an innovative measure of fetal heart rate (HR) and HR variability
(HRV). Women will also complete a structured interaction task with their romantic partner or closest support
person; involving discussions of how each cope with racism-related stressors. Within 48 hours of birth, infants
will complete the NICU Network Neurobehavioral Scale (NNNS) to assess how prenatal exposure to racism may
affect newborn birth outcomes. This short-term longitudinal study lays the foundation for further follow-up of
infants and women into early childhood and a programmatic line of research devoted to understanding and
intervening with marginalized mothers and children to reduce the effects of racism on family health and wellbeing.
