New Research Links Gender, Racial Microaggressions to Higher Postpartum Blood Pressure

Acts of discrimination during pregnancy or childbirth, even as subtle or implicit “microaggressions,” can significantly impact women and individuals who are gender nonconforming. Research has supported the prevalence of these disparities as they intersect with race, gender, and income level.¹

According to the latest provisional data reported by the CDC, the maternal mortality rate is 19.6 per 100,000 live births as of June 2024, with Black patients suffering the overwhelmingly highest rate of fatal outcomes at 51.2.² While comparatively lower, even the rates among other US demographics, including Hispanic (13.8), Asian (14.6), and White (15.3), contribute to the nation's ranking for the worst maternal health outcomes across all high-income countries.³

Findings indicated the combined effects of racism exacerbated these health issues, as women who faced microaggressions and lived in areas characterized by high structural racism had the highest blood pressure.

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Data published today has even connected the experience of gender-based racial microaggressions during obstetrical care with higher postpartum blood pressure.⁴

“We need high blood pressure monitoring and interventions to extend further into the period after birth when blood pressure may continue to be sensitive to social drivers of health as well as racial microaggressions,” lead study author Teresa Janevic, PhD, MPH, associate professor of epidemiology at Columbia University Mailman School of Public Health, said in a statement.

Findings published by the CDC in 2023 revealed that 20%, or 1 in 5 patients, with children younger than 18 reported mistreatment while receiving maternity care for their youngest child.⁵ The rate increased to approximately 30% when focusing specifically on Black, Hispanic, and multiracial mothers, as well as those with public insurance or no insurance.

The new study published today in Hypertension explored how this form of discrimination, including remarks like "calm down" or accusations of anger when speaking assertively, might influence postpartum patients’ blood pressure.⁶

The current researchers surveyed 373 Black, Hispanic, and Asian women delivering at 4 hospitals in Philadelphia and New York City from March to October 2022. Participants used a validated 26-item scale to report their experiences with microaggressions and monitored their blood pressure at home for 3 months postpartum; results found more than one-third (37.5%) reported experiencing at least 1 microaggression during their obstetrical care.

The average systolic and diastolic blood pressure rates were, respectively, 2.12 mm Hg and 1.43 mm Hg higher in the patients who reported microaggressions when compared with those who did not report such experiences.

The study further indicated that the combined effects of racism exacerbated these health issues, as women who faced microaggressions and lived in areas characterized by high structural racism had the highest blood pressures; their average systolic pressure was 7.55 mm Hg higher than that of individuals in low-racism areas who did not experience microaggressions.

In a previous interview addressing the 2023 CDC data on mistreatment, Veronica Gillispie-Bell, MD, MAS, head of Women's Services at Ochsner Medical Center, Kenner, and the director of Quality for Women's Services for Ochsner Health, explained that mothers, especially mothers of color, aren’t respected when they express pain or concerns; the health care system often fails to respond appropriately.⁵

During the interview, Gillispie-Bell referenced Torie Bowie, the American Olympic athlete who abstained from seeking formal health care for her pregnancy complications because she believed it to be futile.

“Because there is so much of this data now and so many stories of not being respected when you come into the health care system, many Black women and women of color are choosing to not come into the health care system,” she said to The American Journal of Managed Care^®. “They’re either delaying their time of coming in or choosing to not interact with with the structural health care system at all, and that is resulting in some of our maternal deaths.”

While the current study acknowledged limitations, including the absence of pre-pregnancy blood pressure data and other health factors, it further supports the credibility of the cumulative health impacts of racism.⁶

“These results emphasize that hypertension management needs to extend beyond prescription medications,” Natalie A. Cameron, MD, MPH, internal medicine specialist and instructor in preventive medicine at Northwestern University’s Feinberg School of Medicine, stated.⁴ “Future work is needed to design interventions that reduce gendered racial microaggressions in the health care setting and investigate their effects on postpartum blood pressure.”

References

1. Grossi G. Confronting deadly maternal health disparities, part 1: US implements doula support. The American Journal of Accountable Care. 2024;12(2):50-53. doi:10.37765/ajac.2024.89573

2. Provisional Maternal Mortality Rates. CDC. Updated October 16, 2024. Accessed January 8, 2024. https://www.cdc.gov/nchs/nvss/vsrr/provisional-maternal-deaths-rates.htm

3. Grossi G. US women face worst health access, outcomes among high-income nations. AJMC. August 15, 2024. Accessed January 8, 2025. https://www.ajmc.com/view/us-women-face-worst-health-access-outcomes-among-high-income-nations

4. Race- and gender-based microaggressions linked to higher post-birth blood pressure. Hypertension. News release. January 9, 2024. Accessed January 9, 2024. https://newsroom.heart.org/news/race-and-gender-based-microaggressions-linked-to-higher-post-birth-blood-pressure?preview=c024&preview_mode=True

5. Grossi G. Dr Veronica Gillispie-Bell addresses racial disparities in maternity care. AJMC. August 28, 2023. Accessed January 8, 2025. https://www.ajmc.com/view/dr-veronica-gillispie-bell-racial-disparities-maternity-care

6. Janevic T, Howell FM, Burdick M, et al. Racism and postpartum blood pressure in a multiethnic prospective cohort. Hypertension. Published online January 9, 2025. doi:10.1161/HYPERTENSIONAHA.124.23772