(654) Perceived racism and placentally mediated adverse pregnancy outcomes

Racism is consistently implicated in obstetric disparities and is associated with hypertension (HTN) among non-pregnant individuals. We sought to quantify the extent to which racism, including its characteristics (domains, timing), is associated with placentally-mediated pregnancy complications (plac-comps).

Study Design:

Primary analysis of a prospective cohort. Participants identifying as Black, White, and/or Hispanic, with singleton, non-anomalous gestations were recruited < 22 weeks, 2017-2022, and completed the validated Perceived Racism Scale at enrollment to assess any-time (at any time during life) and recent (within the last year) racism in 11 public/personal, 3 public/observed experience, and 7 employment domains. The primary outcome was a diagnosis of plac-comps (HTN disorders of pregnancy, birthweight < 10% for GA and sex, ± placental abruption).

 

Results:

414 individuals (47% Black, 42% White, 11% Hispanic) were included; 93 (22.4%) had plac-comps. Surveys were completed at a mean of 17.3 (IQR 16.1-20.0) wks. Clinical factors are shown in Table 1. Compared to those without plac-comps, those with plac-comps were more likely to experience racism at any time (65% vs. 47%, p=0.02) and racism across a greater number of domains any-time (8.1 v. 5.6, p=0.002) and recently (mean 4.6 v. 2.6, p< 0.001). Differences were most pronounced in public/personal domains, as those with plac-comps had higher any-time perceived racism in 7 of 11 public/personal domains and higher recent perceived racism in 7 of 11 public/personal domains (all p< 0.05), Figure. In regressions, each additional any-time racism domain conferred a 9% increased odds of plac-comps (aOR 1.09, 95% CI 1.03-1.15). Similarly, each additional recent racism domain conferred a 8% increased odds of plac-comps (aOR 1.08, 95% CI 1.03-1.13).


 

Conclusion:

Among pregnant individuals at high-risk for adverse pregnancy outcomes, racism is present across multiple facets of daily life. Perceived racism was associated with an increased risk of adverse placental outcomes, irrespective of the timing of the exposure.