Postpartum hypertension, or high blood pressure after childbirth, poses significant health risks, including potential long-term cardiovascular issues. Women who experience pregnancy-related hypertensive disorders, such as preeclampsia, are at greater risk for developing hypertension in the postpartum period. However, the role of social factors, such as gendered racial microaggressions in healthcare settings, in influencing blood pressure during the postpartum period is not well understood.
This study explored whether gendered racial microaggressions—subtle, often unintentional slights based on both gender and race—experienced during pregnancy and childbirth could contribute to higher blood pressure postpartum. The research specifically examined Black, Hispanic, and South Asian women who delivered at four hospitals in Philadelphia and New York City.
A total of 373 participants were surveyed using the Gendered Racial Microaggressions Scale (GRMS), a 26-item tool assessing the frequency of gendered racial microaggressions. Blood pressure readings were taken via home monitoring over a three-month period following delivery. The study also incorporated the Structural Racism Effect Index to estimate the impact of community-level structural racism on the participants’ health.
Key Findings:
Prevalence of Microaggressions: Over a third of the participants reported experiencing at least one gendered racial microaggression during their obstetric care.
Blood Pressure Differences: Those who reported microaggressions had higher average blood pressure readings. Specifically, their three-month average systolic and diastolic blood pressures were 2.12 mm Hg and 1.43 mm Hg higher, respectively, compared to those who did not report microaggressions.
Impact of Structural Racism: The study found the strongest associations between higher blood pressure and microaggressions among participants living in areas with high levels of structural racism. For these participants, the difference in systolic blood pressure was as high as 7.55 mm Hg, and the diastolic difference was 6.03 mm Hg compared to those living in areas with lower structural racism.
Postpartum Period Sensitivity: The associations were particularly strong during the later postpartum period, between 12 days and three months after delivery. This finding suggests that postpartum hypertension remains sensitive to social stressors, such as racial microaggressions, during this critical period.
The study highlights a significant association between the experience of gendered racial microaggressions and elevated blood pressure in the postpartum period. These results emphasize the importance of addressing racial and gender biases in healthcare settings as part of efforts to improve maternal health outcomes. The study suggests that healthcare policies and practices should prioritize the prevention and management of hypertension beyond the immediate postpartum period, incorporating attention to social factors that may influence health.
Further studies are needed to understand the long-term effects of gendered racial microaggressions on cardiovascular health and to develop interventions aimed at reducing these microaggressions in healthcare settings. Additionally, future research should explore how experiences of racism impact both maternal and infant health outcomes.
The study did not track participants’ blood pressure before pregnancy, making it difficult to determine how pre-existing conditions may have influenced the results. Moreover, the research was conducted in only two urban locations, limiting the generalizability of the findings to rural areas.
This research serves as a reminder of the broader social determinants of health that contribute to disparities in maternal health outcomes. It calls for more comprehensive interventions that go beyond medical treatment, focusing also on improving the healthcare experience for marginalized communities.
Expert Opinions:
Teresa Janevic, Ph.D., M.P.H., emphasized the critical need for healthcare professionals and policies to address maternal health care equity, particularly in the postpartum period.
Lisa Levine, M.D., M.S.C.E., pointed out the cumulative effects of microaggressions on long-term health, urging a focus on preventing high blood pressure through social and health interventions.
Natalie A. Cameron, M.D., M.P.H., highlighted that hypertension management should extend beyond medications, incorporating strategies to reduce racial microaggressions in healthcare settings.
This study underscores the importance of considering both social and physiological factors in addressing maternal health disparities.
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