Microaggressions during pregnancy and delivery later linked to higher blood pressure

Experiencing microaggressions based on gender and race while receiving care during pregnancy and delivery may be linked to higher blood pressure postpartum, new research suggests.

The study, published Thursday in the American Heart Association journal Hypertension, found subtle, potentially unintentional slights directed at pregnant people – such as being told to calm down – during obstetric care were associated with higher maternal blood pressure after childbirth and beyond.

"It is well known that Black, Hispanic and South Asian women experience microaggressions during health care," Dr. Teresa Janevic, the study's lead author, said in a news release. Janevic is an associate professor of epidemiology at Columbia University Mailman School of Public Health in New York. "It is not as well known whether these microaggressions may have an association with higher blood pressure."

After giving birth, women may face an elevated risk of developing high blood pressure, also called postpartum hypertension. While the condition is rare, it can be life-threatening and also is linked to a higher risk for developing heart disease later in life. The risk is even greater for women who have pregnancy-related blood pressure issues such as preeclampsia.

For the new analysis, researchers adapted the Gendered Racial Microaggressions Scale, a 26-item, four-factor survey tool, to record pregnant women's experiences during obstetric care. The surveys were filled out by 373 Asian, Black and Hispanic study participants ages 16 to 46 who gave birth at four hospitals in Philadelphia and New York City. Place-based structural racism was measured by matching electronic medical records to census tracts and scoring inequities in eviction rates, median home values, income, education, employment and other factors at the community level.

The study participants were given home blood pressure monitors and asked to text their blood pressure readings twice a day for the first 10 days after they were sent home from the hospital following the delivery of their babies and twice a week for days 11 to 90.

More than one-third of participants reported experiencing at least one race- and gender-based microaggression during obstetrical care. And for those who did, three-month average blood pressure readings were modestly higher than for those who didn't experience any microaggressions.

The highest blood pressure readings came from participants who experienced microaggressions and lived in areas with high levels of structural racism. Conversely, the lowest readings came from participants who lived in areas with the lowest levels of structural racism and who did not report experiencing microaggressions. The difference in systolic blood pressure readings – the top number – between the two groups was 7.55 mmHg, and the gap in diastolic readings – the bottom number – was 6.03 mmHg.

Janevic said the association between microaggressions and high blood pressure was strongest between 12 days and three months postpartum.

"This is an emerging critical period for preventing high blood pressure," she said. "Our findings provide further evidence that health care professionals and policies should focus more intensely on improving maternal health care equity. 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."

The findings "serve as a reminder of the long-term impact that racism can have on one's overall health," Dr. Lisa Levine, the study's senior author, said in the news release. She is an associate professor in reproductive health at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

"The magnitude of these types of physiologic changes may become cumulative over time and lead to the inequities we see in many health outcomes," said Levine, who also is director of the medical school's Pregnancy and Heart Disease Program and chief of the Maternal Fetal Medicine Division.

Dr. Natalie Cameron, an internal medicine specialist and instructor in preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, said the synergistic effects of structural and interpersonal racism were "profound." Cameron was not involved in the study.

"For many people, this can make the difference between needing blood pressure-lowering medications or not," she said in the news release.

"These results emphasize that hypertension management needs to extend beyond prescription medications," Cameron said. "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."