The associations of objective and perceived neighborhood disadvantage with stress among pregnant black women

Superwoman Schema Endorsement and its Association to Perceived Stress During Pregnancy and Birth Outcomes among Non-Hispanic Black American Women

The superwoman schema (SWS), rooted in historical racist stereotypes, acts as a sociocultural construct that many Black American women in the U.S. currently adopt, known as the strong Black woman (SBW) stereotype. This SWS, reinforced by racial discrimination, has been identified as a stressor contributing to psychological strain and mental health disorders. Research indicates that the SWS may negatively affect maternal mental health and perinatal outcomes. However, there is a paucity of research focusing on the SWS's impact on pregnant Black American women regarding their psychological health and birth outcomes. Addressing this gap, this study involved 305 African American women aged 21-45 who reported on their SWS endorsement, perceived stress levels during pregnancy, mental health diagnoses, and birth outcomes. Findings revealed a significant correlation between SWS endorsement and increased stress and a diagnosis of anxiety or depression. A higher SWS endorsement and perceived stress were correlated with caring for others and resisting vulnerability, although no direct link was found between SWS endorsement, perceived stress, and delivering a preterm or low birth-weight infant. Further research is necessary on the SWS's adaptive attributes and its archetypic reification in obstetric care. However, these findings underscore the importance of mental health interventions and support systems for pregnant Black American women, especially among unmarried mothers and those with limited education. This study contributes to understanding the SWS as a racial stressor and a contributory mechanism to racial disparities in maternal and perinatal health.

Associations Among Racial Discrimination, Perceived Stress, and Birth Satisfaction in Black Women in the Postpartum Period

OBJECTIVE

To examine associations among experiences of racial discrimination, perceived stress, and birth satisfaction and to test if perceived stress mediates the relationship between racial discrimination and birth satisfaction among Black women in the postpartum period.

DESIGN

Secondary analysis of data from the Biosocial Impact on Black Births study.

SETTING

A postpartum unit of a large hospital in Central Florida.

PARTICIPANTS

Black women (N = 154) in the postpartum period.

METHODS

Participants completed the lifetime Experiences of Discrimination scale, Perceived Stress Scale and Birth Satisfaction Scale-Revised between 24 hours and 23 days after birth. We calculated descriptive statistics and Spearman's ρ correlation coefficients to evaluate associations among variables. We used multiple linear regression to evaluate perceived stress as a mediator between racial discrimination and birth satisfaction.

RESULTS

Racial discrimination had a positive association with perceived stress (β = 2.445, p = .03), and perceived stress had a negative association with birth satisfaction (β = -0.221, p = .02). Racial discrimination had no significant direct effect on birth satisfaction (β = -0.091, p = .94); therefore, perceived stress did not mediate the relationship.

CONCLUSION

More experiences of discrimination over the life span were associated with higher levels of perceived stress. Participants who reported higher levels of perceived stress reported lower levels of birth satisfaction. Our study adds to the body of knowledge regarding associations between racial discrimination and perceived stress and perceived stress and birth satisfaction.

Mindfulness and Cardiometabolic Health During Pregnancy: An Integrative Review

Objectives

Cardiometabolic health during pregnancy has potential to influence long-term chronic disease risk for both mother and offspring. Mindfulness practices have been associated with improved cardiometabolic health in non-pregnant populations. The objective was to evaluate diverse studies that explored relationships between prenatal mindfulness and maternal cardiometabolic health.

Method

An integrative review was conducted in January 2023 across five databases to identify and evaluate studies of diverse methodologies and data types. Quantitative studies that examined mindfulness as an intervention or exposure variable during pregnancy and reported any of the following outcomes were considered: gestational weight gain (GWG), blood glucose, insulin resistance, gestational diabetes, inflammation, blood pressure, hypertensive disorders of pregnancy. Qualitative studies were included if they evaluated knowledge, attitudes, or practices of mindfulness in relation to the above-mentioned outcomes during pregnancy.

Results

Fifteen eligible studies were identified, and 4 received a "Good" quality rating (1/7 interventional, 1/5 observational, 2/2 qualitative). Qualitative studies revealed interest among pregnant women in mindfulness-based practices for managing GWG. Some beneficial effects of mindfulness interventions on maternal glucose tolerance and blood pressure were identified, but not for other cardiometabolic outcomes. Observational studies revealed null direct associations between maternal trait mindfulness and cardiometabolic parameters, but one study suggests potential for mindful eating to mitigate excess GWG and insulin resistance.

Conclusions

There currently exists limited quality evidence for mindfulness practices to support prenatal cardiometabolic health. Further rigorous studies are required to understand whether prenatal mindfulness-based interventions, either alone or in combination with other lifestyle modalities, can benefit cardiometabolic health.

Preregistration

This study is not preregistered.

Environmental Justice Index and adverse pregnancy outcomes

BACKGROUND

The Environmental Justice Index is a tool released by the Centers for Disease Control and Prevention that quantifies and ranks the environmental burden and social vulnerability of each census tract. Racial and ethnic disparities in adverse pregnancy outcomes are well established. The relative contributions of individual (person-level) and environmental (neighborhood-level) risk factors to disease prevalence remain poorly understood.

OBJECTIVE

This study aimed to determine whether the Environmental Justice Index is associated with adverse pregnancy outcomes after adjustment for individual clinical and sociodemographic risk factors.

STUDY DESIGN

This was a retrospective cross-sectional study of all patients who delivered a singleton newborn at ≥23 weeks of gestation between January 2019 and February 2022 at 7 hospitals within a large academic health system in New York. Patients were excluded if their home address was not available, if the address could not be geocoded to a census tract, or if the census tract did not have corresponding Environmental Justice Index data. Patients were also excluded if they had preexisting diabetes or hypertension. For patients who had multiple pregnancies during the study period, only the first pregnancy was included for analysis. Clinical and demographic data were obtained from the electronic medical record. Environmental Justice Index score, the primary independent variable, ranges from 0 to 1. Higher Environmental Justice Index scores indicate communities with increased cumulative environmental burden and increased social vulnerability. The primary outcome was adverse pregnancy outcome, defined as the presence of ≥1 of any of the following conditions: hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth restriction, low birthweight, small for gestational age newborn, placental abruption, and stillbirth. Multivariable logistic regression was performed to investigate the relationship between Environmental Justice Index score and adverse pregnancy outcome, adjusting for potential confounding variables, including body mass index group, race and ethnicity group, advanced maternal age, nulliparity, public health insurance, and English as the preferred language.

RESULTS

A total of 65,273 pregnancies were included for analysis. Overall, adverse pregnancy outcomes occurred in 37.6% of pregnancies (n=24,545); hypertensive disorders of pregnancy (13.4%) and gestational diabetes (12.2%) were the most common adverse pregnancy outcome conditions. On unadjusted analysis, the strongest associations between Environmental Justice Index score and individual adverse pregnancy outcome conditions were observed for stillbirth (odds ratio, 1.079; 95% confidence interval, 1.025-1.135) and hypertensive disorders of pregnancy (odds ratio, 1.052; 95% confidence interval, 1.042-1.061). On multivariable logistic regression, every 0.1 increase in Environmental Justice Index score was associated with 1.4% higher odds of adverse pregnancy outcome (adjusted odds ratio, 1.014; 95% confidence interval, 1.007-1.021). The strongest associations with adverse pregnancy outcomes were observed with well-established clinical and social risk factors, including class 3 obesity (adjusted odds ratio, 1.710; 95% confidence interval, 1.580-1.849; reference: body mass index <25 kg/m2) and certain race and ethnicity groups (reference: non-Hispanic White), particularly Asian and Pacific Islander (adjusted odds ratio, 1.817; 95% confidence interval, 1.729-1.910), and non-Hispanic Black (adjusted odds ratio, 1.668; 95% confidence interval, 1.581-1.760) people.

CONCLUSION

Environmental Justice Index score is positively associated with adverse pregnancy outcomes, and most strongly associated with stillbirth and hypertensive disorders of pregnancy. Geospatial analysis with Environmental Justice Index may help to improve our understanding of health inequities by identifying neighborhood characteristics that increase the risk of pregnancy complications.