Rise in post-birth blood pressure in Asian, Black, and Hispanic women linked to microaggressions

A study of more than 400 Asian, Black and Hispanic women who had recently given birth found that racism through microaggressions may be linked to higher blood pressure during the period after their baby was born, according to a new study by Columbia University Mailman School of Public Health. More than one-third of the mothers reported experiencing at least one microaggression related to being a woman of color during or after their pregnancy. The research conducted with colleagues at the University of Pennsylvania noted that these types of gendered racial microaggressions suggest blood pressure monitoring and/or treatment for high blood pressure may need to be continued for a longer time after birth. The findings are published in the journal Hypertension, the peer-reviewed journal of the American Heart Association.

“We found that the link between gendered racial microaggressions and postpartum blood pressure was strongest 10 or more days after delivery, during the period after a baby is born when the mother’s blood pressure is monitored less often,” said Teresa Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School and first author. “It is well-known that Black, Hispanic and South Asian women experience microaggressions during health care. It is not as well known how these microaggressions may ‘get under the skin’ to influence their blood pressure,” said Janevic.

In the first year following childbirth, women have an increased risk of developing high blood pressure, which can sometimes be life-threatening and may be associated with developing heart disease later in life. This is especially true in people that had any pregnancy-related high blood pressure issue such as preeclampsia. Previous research has found that Black, Hispanic and South Asian women are at a higher risk of developing heart disease later in life with much of that risk being linked to hypertension.

While previous research has also established links between high blood pressure and racial discrimination, the potential connection between high blood pressure and racial microaggressions — subtle unintentional slights, such as being told to calm down — experienced by pregnant and postpartum women while receiving health care services during pregnancy and delivery needs to be explored, according to the authors.

The study included 373 patients who delivered live babies at four maternity hospitals located in Philadelphia and Queens, New York, between March and October 2022. Study participants ranged from 16 to 46 years old; approximately 43 percent were 20-29 years old; 40 percent of participants self-identified as Hispanic; 39 percent as Black; 10 percent as Asian; and 11 percent selected “other.

Researchers used the Gendered Racial Microaggressions Scale (GRMS), adapted for the obstetric care setting into a 9-item, one-factor scale, to ask women located in four hospitals in Philadelphia and New York City how frequently they experienced gendered racial microaggressions. The women were asked to check their blood pressure at home for three months after birth using text-based monitoring. Researchers also estimated the racism experienced by communities with the Structural Racism Effect Index, a publicly available national index.

The survey asked patients to report how frequently they experienced gendered racial microaggressions (0 = never to 5= once a week or more). Participants were given validated blood pressure monitors and asked through text messaging to record their blood pressure twice a day for the first 10 days after delivery and then twice a week after for the next three months.

The analysis found:

• More than one-third of participants reported experiencing at least one gendered racial microaggression during their obstetrical care.
• The highest three-month average blood pressures came from participants who experienced microaggressions and lived in areas with high levels of structural racism, while the lowest average blood pressures were observed in participants who lived in areas with low levels of structural racism and who didn’t report experiencing microaggressions.

“It’s surprising the associations were strongest in the later postpartum period between 12 days and three months after delivery. This is an emerging critical period for preventing high blood pressure,” Janevic 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.”

Future research is needed to explore how experiencing racism influences blood pressure, to understand the potential health effects on infants and to identify the best interventions to improve postpartum health, Janevic noted.

Co-authors, disclosures and funding sources are listed in the manuscript.