Impacts of structural racism on racial and ethnic disparities in perinatal health - ABSTRACT Women of color have higher rates of poor pregnancy outcomes than non-Hispanic whites in the U.S. For example, the prevalence of preterm birth is 14.4%, 10.0% and 9.3% among Black, Hispanic, and non-Hispanic white mothers, respectively. Hispanic and Black women are also at higher risk of maternal morbidities such as hypertension in pregnancy and gestational diabetes. Along with the compelling evidence of the impact of adverse perinatal health on the health of a mother and her infant throughout the life course comes high societal and economic costs. Yet, the etiology of adverse pregnancy outcomes among women of color is not fully explained by genetics, behavior, or access to care and other factors, including structural racism, likely play a role. Historically, communities of color have been, and continue to be, burdened by downstream effects of redlining practices, including housing discrimination and neighborhood segregation. Given the proximity of their neighborhoods to key sources of air, water, and soil pollution (another consequence of redlining), communities of color also experience environmental racism, i.e., a disproportionate burden of environmental exposures. Moreover, women in high-risk communities are subject to spillover stress from disproportionate policing, police violence, arrests, and incarceration. While there is growing evidence of the impact of structural racism on perinatal health, findings are equivocal, and research related to the joint impact of multiple forms of structural racism is lacking. In this application, we will assess the independent effects of structural racism across multiple domains on racial/ethnic disparities in both maternal morbidity (hypertension in pregnancy and gestational diabetes) and adverse pregnancy outcomes (low birth weight and preterm birth), explore whether combined exposures to multiple domains of structural racism enhance disparities, and apply machine learning methods to identify the key structural racism predictors of adverse perinatal health outcomes. To achieve our aims, we will construct a retrospective birth cohort of women who delivered infants at major obstetric hospitals in the 3rd largest county (Harris) in the U.S. (where Houston is located) that will include follow-up throughout a mother’s pregnancy to the birth of her infant. Our project leverages established partnerships among Baylor College of Medicine, UTHealth McGovern Medical School, and Texas Southern University through our NIMHD/NIEHS/NICHD P50 Center of Excellence on Environmental Health Disparities Research, focused on reducing environmental health disparities in maternal and child health, and draws on our collective expertise in environmental and perinatal epidemiology, women’s health, maternal-fetal medicine, criminal justice, social science, biostatistics, and bioinformatics. This work is expected to elucidate the contribution of structural racism across multiple domains on racial/ethnic disparities in several key perinatal health outcomes. Importantly, the results from this study will also enhance our understanding of the complex interplay and identification of key structural racism drivers of perinatal health disparities and lay the foundation for future studies to promote interventions.
