Experiences of discrimination, paternal support, and hypertensive disorders of pregnancy (HDP) in the MIEHR study, Houston, Texas

BACKGROUND: Discrimination is a psychosocial stressor that, through activation of stress-response pathways, may influence risk of adverse perinatal health outcomes. However, few studies have evaluated the association between discrimination and hypertensive disorders of pregnancy (HDP), and none have explored effect modification by race or paternal support, which may buffer the adverse effects of discrimination. METHODS: We included 1,847 non-Hispanic Black and White participants from the Maternal and Infant Environmental Health Riskscape (MIEHR) study. Krieger's validated Experiences of Discrimination (EOD) scale was used to assess occurrence (yes/no) and frequency (once, 2-3, ≥ 4 times) of discrimination in nine situations. We created continuous scores representing total situations and frequency and also categorized (0, 1-2, ≥ 3) the situations score. Using electronic health records, we identified participants with HDP (hypertension in pregnancy, preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome). We applied log-binomial regression to evaluate associations between experiences of discrimination and HDP, adjusted for maternal age, pre-pregnancy body mass index, income, and race. Analyses were stratified by race and self-reported paternal support (none/a little vs. good/excellent) as potential effect modifiers; due to small numbers, the situation score was dichotomized (0, ≥ 1) for these analyses. RESULTS: HDP occurred in 37.5% (n = 430) of Black and 26.0% (n = 182) of White participants. Compared with participants reporting no discrimination, the adjusted risk ratio (aRR) was 1.13 (95% CI: 0.96, 1.33) and 1.11 (95% CI: 0.94, 1.30) for those reporting discrimination in 1-2 and ≥ 3 situations, respectively. By setting, the strongest associations were observed for discrimination in getting a job (aRR: 1.22; 95% CI: 1.14, 1.43), by police (aRR: 1.21; 95% CI: 1.01, 1.44), and getting medical care (aRR: 1.17; 95% CI: 0.94, 1.44). Stratified analyses revealed the strongest associations between experiencing discrimination and HDP among Black participants and those with lower perceptions of paternal support. CONCLUSIONS: We found associations between discrimination and HDP among Black participants, who bear the greatest burden of HDP, as well as a potential buffering effect of paternal support. Future research is needed to investigate associations between discrimination and HDP and evaluate whether enhancing paternal support can mitigate the impact of discrimination on HDP risk.