Pregnancy as a Window to Racial Disparities in Hypertension

Society for Maternal-Fetal Medicine Position Statement: Extending Medicaid coverage for 12 months postpartum

Position: The Society for Maternal-Fetal Medicine supports federal and state policies that expand Medicaid eligibility and extend Medicaid coverage through 12 months postpartum to address the maternal morbidity and mortality crisis and improve health equity. Access to coverage is essential to optimize maternal health following pregnancy and childbirth and avoid preventable causes of maternal morbidity and mortality that extend throughout the first year postpartum. The Society opposes policies such as work requirements or limitations on coverage for undocumented individuals that unnecessarily impose restrictions on Medicaid eligibility.

Correlates of Hypertensive-Level BP in African American Adolescents

OBJECTIVE

Adult cardiovascular disease has its roots in childhood and adolescence. Risks for pediatric hypertension include obesity, male sex, and minority race. We identified risk factors associated with hypertension specifically among African American adolescents ages 13-18.

METHODS

We analyzed data from the US National Health and Nutrition Examination Surveys from 2011 to 2018, defining BP consistent with hypertension as average systolic or diastolic BP ≥ 130/80 mmHg or taking medication for a clinical diagnosis of hypertension. Univariate analyses compared characteristics of adolescents with and without hypertensive-level BP. Logistic regression was completed to more precisely identify risk factors.

RESULTS

Among 838 African American adolescents, 48 met criteria for hypertensive-level BP, for a population prevalence of 5.8%. Due to low rates of hypertensive-level BP in girls (2.7%), our analysis focused on the subset of boys, who had an 8.9% prevalence rate, increasing to 26.1% for boys with obesity and 35.3% for boys with severe obesity. Boys with hypertensive-level BP had significantly lower family incomes, higher rates of being in single-parent families, more frequent consumption of fast food, were more likely to be taking prescription medications for psychiatric diagnoses, and had higher A1c and cholesterol values.

CONCLUSIONS

Our study confirms the much higher risk for hypertensive-level BP in African American boys and emphasizes the important role of social determinants of health in this common illness.

Ecological momentary assessment of stress, racism and other forms of discrimination during pregnancy using smartphone technology

BACKGROUND

In the United States, there are considerable racial inequities in adverse perinatal outcomes. Exposure to racism, sexism, and other forms of oppression may help explain these inequities.

OBJECTIVES

To describe the application of real-time data collection using ecological momentary assessment (EMA) and smartphone technology to assess exposure to stress, racism, sexism, microaggressions, and other forms of oppression.

METHODS

The Postpartum Mothers Mobile Study (PMOMS) is an ongoing longitudinal cohort study that began recruitment in December 2017. Participants delivering at a hospital in Pittsburgh, PA are recruited by 29 weeks' gestation. Using smartphones and smart scales, participants complete daily surveys related to psychosocial, behavioural, and contextual factors and weigh themselves weekly for approximately 15 months. We provide a preliminary descriptive analysis of EMA self-reported measures of stress, racism, sexism, and microaggressions; and non-EMA measures of stress and major discrimination.

RESULTS

The sample (n = 230) is 63.5% White, 24.8% Black/African American, and 7% Hispanic origin. The most commonly reported item from the Major Discrimination Scale is being unfairly fired (18.1% of the sample). Of those, 31.7% and 17.1% attribute unfair firing to their gender and race, respectively. From the random EMA measures, on average, participants report experiences of racism and sexism at least once daily, in an average 12-hour day over the 4-week period. Black participants indicate about two experiences per day of racism, and White participants indicate more than 1 per day of sexism. Mean stress levels from the EMA measures were similar to the stress measures collected at baseline.

CONCLUSIONS

The methods applied in PMOMS provide real-time data regarding how participants' daily experiences of stress and discrimination influence their lives. Future work will include understanding if and how these EMA measures may relate to already established measures of racism, sexism, and stress; and ultimately understanding associations with perinatal inequities.