Associations Between Self-Reported Experiences of Racial Discrimination and Hypertensive Disorders of Pregnancy among Black and White Women in the Coronary Artery Risk Development in Young Adults Study

Abstract Introduction Hypertensive disorders of pregnancy (HDP) are major contributors to maternal morbidity, mortality, and long-term cardiovascular risk. Perceived experiences of racial discrimination (EORD) have been associated with adverse cardiovascular outcomes. This study investigates the association between EORD and incident HDP among Black and White women. Methods The Coronary Artery Risk Development in Young Adults study is a prospective cohort of 5,115 Black and White adults aged 18 to 30 years at baseline (1985–1986), followed for over 30 years. EORD was analyzed as a continuous proportion, a three-category variable (no discrimination, overall proportion < 33%, and 33% or greater), and dichotomously (none vs. ever). HDP was self-reported in pregnancies lasting at least 23 weeks. Logistic regression assessed the association between EORD and HDP among 1,184 parous women, adjusting for age, race, education, income, cardiovascular risk factors, and parity. Results At baseline, the mean age was 24.1 years; 48.1% were Black, 72.3% were nulliparous, and 19.7% had an income less than $16,000. Overall, 60.6% reported EORD (86.0% of Black and 37.1% of White women). Those reporting EORD were more likely to be Black, unmarried, have higher BMI, and have had one birth at baseline ( p < 0.001). EORD was associated with increased odds of HDP (OR: 1.73 [1.20–2.48]) among both Black and White women. EORD < 33% (OR: 1.75 [1.20–2.55]) and 33% or greater (OR: 1.65 [1.04–2.64]) were significantly associated with HDP. Conclusions/Implications EORD, regardless of race, is significantly associated with increased odds of HDP. The disproportionate burden among Black women highlights the need for targeted interventions.