# Racial, Ethnic, and Color-Based Discrimination and Pre-Pregnancy Risk Factors for Preeclampsia Among Nulliparous Patients

## TL;DR

Experiencing racial, ethnic, or color-based discrimination is linked to higher rates of obesity and chronic hypertension in pregnant women, especially among Hispanic individuals.

## Contribution

This study demonstrates a dose-dependent relationship between self-reported discrimination and pre-pregnancy risk factors for preeclampsia in a U.S. cohort.

## Key findings

- High self-reported racial, ethnic, and color-based discrimination was associated with a 1.75-fold increased odds of obesity and/or chronic hypertension.
- The association was statistically significant only among Hispanic participants when stratified by race and ethnicity.
- Discrimination experiences were unequally distributed, with non-Hispanic Black participants reporting the highest levels.

## Abstract

Obesity and chronic hypertension are well-known risk factors for maternal morbidity and mortality. Evidence suggests racism contributes to the development of these chronic conditions.

We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes: monitoring mothers-to-be (nuMoM2b) cohort, which recruited nulliparous pregnant participants in the United States in 2010–2013. Using logistic regression, we assessed the relationship between experiences of racial, ethnic, and color-based (REC) discrimination (categorized as high, low, or no REC discrimination) and prevalence of a composite outcome of obesity and/or chronic hypertension.

Among 8,554 participants, the composite outcome was unequally distributed by race and ethnicity (p < 0.001), present in 19.9% of non-Hispanic White, 23.1% of Hispanic, and 39.0% of non-Hispanic Black participants. Self-reported REC discrimination was similarly unequally distributed (p < 0.001), with high REC discrimination reported by 17.5% of non-Hispanic Black, 10.6% of Hispanic, and 2.1% of and non-Hispanic White participants. In multivariable analyses, high self-reported REC discrimination was associated with a 1.75 adjusted odds ratio (95% confidence interval: 1.43–2.14) of the composite outcome compared with those reporting no REC discrimination. When stratified by race and ethnicity, the odds ratios for the composite outcome among those reporting high REC discrimination were only statistically significant among the Hispanic subgroup.

We observed a positive, dose-dependent association between self-reported REC discrimination and our outcome of obesity and/or chronic hypertension. By demonstrating this relationship in an obstetric cohort, we aim to highlight the role of racism over the life course in contributing to chronic health conditions and associated maternal outcomes.