Race-, gender-based microaggressions during obstetric care tied to higher postpartum BP
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Key takeaways:
- Gendered racial microaggressions during obstetric care may confer elevated blood pressure postpartum.
- Microaggressions include being told to calm down and being accused of aggression when speaking assertively.
Gendered racial microaggressions during obstetric care were associated with elevated blood pressure among postpartum individuals up to 3 months after delivery, researchers reported.
A study evaluating the impact of gendered racial microaggressions on postpartum BP among Asian, Black and Hispanic people was published in Hypertension.
“Postpartum hypertension is a major cause of maternal morbidity and mortality, and we were seeking modifiable factors that may influence patients’ BP after they return home from the hospital. We had heard previously from interviews with women that they experience being ignored or unheard during their obstetric care, and we sought to investigate how this may influence their postpartum health,” Teresa M. Janevic, PhD, MPH, associate professor of epidemiology at Columbia University Mailman School of Public Health, told Healio.
Janevic and colleagues conducted the present study to understand the association between gendered racial microaggressions during obstetric care and postpartum BP within a prospective cohort of 373 self-reported Asian (10.5%), Black (38.6%), Hispanic (40%) and other (11%) race/ethnicity in New York City and Philadelphia.
Nearly half of participants were aged 20 to 29 years and slightly more than half were born outside of the United States.
Patients were surveyed at the time of delivery about their experiences with gendered racial microaggressions during obstetric care and BP was assessed for 3 months after via text-based monitoring.
The researchers used a gendered racial microaggressions scale to assess the frequency of microaggressions in this population. The scale was initially developed to capture participants’ experiences as a Black woman and was later adapted where participants’ perspectives from their race and gender positionality is inferred, according to the study.
Examples of reported gendered racial microaggressions included “I have been disrespected,” “someone told me to calm down” and “someone accused me of being angry when speaking assertively.”
Overall, 37.5% of participants reported experiencing at least one gendered racial microaggression during obstetric care.
Compared with those who experienced none, those with at least one gendered racial microaggression had approximately 1.88 mm Hg higher systolic BP from days 1 to 10 postpartum (95% CI, 0.19 to 3.95) and 2.19 mm Hg higher systolic BP from days 11 to 85 postpartum (95% CI, 0.17-4.22), according to the study.
Findings were similar for diastolic BP.
“Because we had heard in interviews previously that microaggressions during obstetric care can cause distress, I was not surprised that there may be effects continuing into the postpartum period,” Janevic told Healio. “What did surprise me is overall the number of women who have elevated BP still 3 months postpartum, and that associations with microaggressions seemed to be strongest in the second and third month postpartum.”
Alongside reported incidents of gendered racial microaggressions, Janevic and colleagues assessed the Structural Racism Effect Index, a publicly available national index designed to measure community-level inequity across nine domains: built environment, criminal justice, education, employment, housing, income and poverty, social cohesion, transportation, and wealth.
The researchers reported that participants who experienced at least one gendered racial microaggression during care and living in an area with high Structural Racism Effect Index had systolic BP approximately 7.55 mm Hg higher (95% CI, 3.41-11.69) and diastolic BP approximately 6.03 mm Hg higher (95% CI, 2.66-9.41) compared with participants with neither experience.
“Microaggressions most likely need to be stemmed at a structural level. For example, hospitals need to be sufficiently resourced to provide training and support for staff, as well as implement mechanisms of accountability,” Janevic told Healio. “Meanwhile, measures to mitigate microaggressions, for example the presence of a doula during obstetric care, may empower patients and lead to better outcomes.”
For more information:
Teresa M. Janevic, PhD, MPH, can be reached at 722 West 168th St., New York, NY 10032.
Reference:
- Race- and gender-based microaggressions linked to higher post-birth blood pressure. https://newsroom.heart.org/news/race-and-gender-based-microaggressions-linked-to-higher-post-birth-blood-pressure. Published Jan. 9, 2025. Accessed Jan. 9, 2025.
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