Racism in the form of micro aggressions and the risk of preterm birth among black women

Abstract

Purpose-This study sought to examine whether perceived interpersonal racism in the form of racial micro aggressions was associated with preterm birth (PTB) and whether the presence of depressive symptoms and perceived stress modified the association. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods-Data HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript depressive symptomatology was measured by the Centers for Epidemiologic Studies-Depression scale (CES-D) dichotomized at ≥23. Restricted cubic splines were used to model non-linearity between perceived racism and PTB. We used the Perceived Stress Scale (PSS) to assess general stress perceptions.Results-Stratified spline regression analysis demonstrated that among those with severe depressive symptoms, perceived racism was not associated with PTB. However, perceived racism was significantly associated with PTB among women with mild to moderate (CES-D score ≤22) depressive symptoms. Perceived racism was not associated with PTB among women with or without high amounts of perceived stress.Conclusions-Our findings suggest that racism, at least in the form of racial micro aggressions, may not further impact a group already at high risk for PTB (those with severe depressive symptoms), but may increase the risk of PTB for women at lower baseline risk.

Neighborhood disadvantage and preterm delivery in Urban African Americans: The moderating role of religious coping

“…The primary objective of the study was to determine how racism is associated with PTD. 33 Self-identified African American women (≥18 years old) who delivered a singleton infant, were recruited at a hospital in Oakland County, Michigan. Women were excluded from the study if they: (1) did not speak English or (2) had intellectual disabilities, serious cognitive deficits, or significant mental illness, on the basis of history or any prior records.…”

Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth

“…There is theoretical discourse, but limited direct evidence, linking the pathways and mechanisms for stress related to discrimination, racism or disrespect in healthcare to negative health outcomes such as PTB (Slaughter-Acey et al, 2016;Congdon et al, 2016;Geronimus et al, 2015). Given the consistency of the limited reports of its pervasiveness and profound potential impact, further research is urgently needed that incorporates the perspectives of women of color to address disrespect in health service delivery and reduce the perceived stress associated with pregnancy related care for all women.…”

“…It is hypothesized that women of color experience longer lifetime exposure to chronic stress, which may lead to fluctuations in allostatic load (wear and tear) and contribute to the higher risk of PTB for these women (Braveman et al, 2015;Giurgescu et al, 2011). Other investigators have suggested that women of color experience discrimination, racism and disrespect in healthcare encounters and that this affects the health of women and their infants (Rankin et al, 2011;Tucker Edmonds et al, 2015;Ertel et al, 2012;Pullen et al, 2014;Nuru-Jeter et al, 2009;Dominguez et al, 2008;Slaughter-Acey et al, 2016). A recent study (SlaughterAcey et al, 2016) found significant associations between racial mircoaggressions and PTB in women who had mild to moderate, but not severe, depressive symptoms, but did not find a significant association between PTB and overall perceived stress.…”

Applying a critical race lens to relationship‐centered care in pregnancy and childbirth: An antidote to structural racism

“…In addition, racial discrimination and experiences of interpersonal racism such as implicit racial bias and microaggressions during clinical encounters create disproportionate barriers to high‐quality, respectful, patient‐centered care experienced by Black people . Perinatal care, as currently designed and delivered in most settings in the United States, has proven woefully inadequate for addressing structural and interpersonal racism in the day‐to‐day experiences of Black birthing people and in their encounters with the health care system . Health care services that are grounded in relationships that acknowledge dynamics of power and that foster mutual respect may help shift pernicious patterns of racial inequity in perinatal care and childbirth.…”

“…[5][6][7][8] Perinatal care, as currently designed and delivered in most settings in the United States, has proven woefully inadequate for addressing structural and interpersonal racism in the day-to-day experiences of Black birthing people and in their encounters with the health care system. [8][9][10][11] Health care services that are grounded in relationships that acknowledge dynamics of power and that foster mutual respect may help shift pernicious patterns of racial inequity in perinatal care and childbirth.…”