If you’re a Black woman who’s been to a doctor’s office, chances are you’ve experienced it: a white doctor’s offhand, patronizing comment about your body — or an assistant asking you to calm down when you’re really not angry.
Now, a new study has found that those kinds of microaggressions towards pregnant women of color, experienced in a healthcare setting, can trigger a rise in the women’s blood pressure immediately after childbirth — increasing the risk of health conditions linked to maternal mortality.
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The study, published last week in the American Heart Association journal Hypertension, found that elevated maternal blood pressure can potentially last past childbirth, adding to disparate health outcomes between white women and women of color.
“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,” she said.
By age 55, research shows 3 of 4 Black adults have already developed the condition.
The U.S. has the highest maternal mortality rate of any high-income country, and Black women are almost three times more likely to die from giving birth than white women. Some of the reasons cited include lack of health care coverage, insufficient postpartum care, and racial discrimination.
More than one-third of Asian, Black and Hispanic women the JAHA research studied said they had experienced at least one microaggression related to race and gender — being disrespected during medical visits, or accused of being angry when speaking assertively or asking direct questions — during or after their pregnancy.
This tracks with the roughly 40% of Black, Hispanic, and multiracial mothers who reported being discriminated against when receiving maternity care, and 45% of all mothers who said they were reluctant to ask questions or discuss concerns with their healthcare provider, according to an April 2023 report from the Centers for Disease Control.
“[R]acial disparities exist both within hospitals and between hospitals for maternal morbidity,” according to a Commonwealth Fund report. “Inequities in access to care and patients’ experience of care are often rooted in discrimination and clinician bias.”
Hypertension during pregnancy or soon after childbirth is a crucial factor in the disparate maternal mortality rates in the U.S. The link between racial microaggressions and postpartum blood pressure was strongest 10 or more days after giving birth.
This is a crucial period: two-thirds of pregnancy-related deaths in the U.S. happen between the first day and first year after childbirth. That led JAHA researchers to suggest doctors may need to monitor and treat postpartum blood pressure longer than current guidelines.
A life-threatening condition, postpartum hypertension is linked to a higher risk of developing heart disease later in life. The risk is greater for women who have pregnancy-related blood pressure issues, such as preeclampsia.
The AHA analysis studied 373 Asian, Black, and Hispanic 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 social determinants of health.
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The participants received home blood pressure monitors and were instructed to text their readings twice a day for the first 10 days back home following the delivery of their babies, and twice a week every day after that for up to 90 days.
Participants who likely experienced microaggressions and lived in areas with high levels of structural racism had the highest blood pressure readings. 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 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. An associate professor in reproductive health at the University of Pennsylvania Perelman School of Medicine in Philadelphia, she warned that effects are key factors in health disparities between whites and marginalized groups.
“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.
Dr. Natalie Cameron, an internal medicine specialist and instructor in preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, was not involved in the study, but said the synergistic effects of structural and interpersonal racism were “profound.”
“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.”
The new JAHA study echoes findings from earlier research linking exposure to persistent racism with elevated stress levels and the presence of high blood pressure in the wider Black population.
That study shows hypertension affects Black adults — particularly women — earlier and with worse outcomes than whites. By age 55, research shows 3 of 4 Black adults have already developed the condition compared to about half of white men and 40% of white women.