Correlates and consequences of gendered racial stress among pregnant Black women Public
Clarke, Lasha (Summer 2021)
Abstract
Racial disparities in gestational age persist after control for sociobehavioral factors. Gestational ages before term are associated with greater maternal and infant morbidity. A confluence of evidence supports that racism, acting as a stressor for Black women, underlies this disparity. Given their intersecting identities as both Black and women, Black women may experience a distinct, hybrid form of stress called gendered racial stress. Considering a biopsychosocial framework of cumulative risk over the lifecourse, gendered racial stress may be a mechanism through which pregnancy outcomes are affected. Gaps in the growing literature on Black maternal gendered racial stress include: limited use of available intersectional measures; gendered racism’s earlier life correlates; its association with embodied biomarkers of stress; and its effect on gestational age. This dissertation uses data from a prospective cohort study of pregnant Black women seeking prenatal care in Atlanta, GA to address these gaps.
In Aim 1, we assessed the association of adverse childhood experiences (ACEs) with adult gendered racial stress. Increased ACEs were associated with increased gendered racial stress scores, even after control for confounders. This association appeared stronger among women who reported accepting unfair treatment and keeping it to themselves, versus those who reported saying and/or doing something about it.
In Aim 2, we estimated the marginal effect of gendered racial stress on spontaneous preterm (sPTB) and early term birth (sETB). We found null associations of total gendered racial stress and most subscale (i.e., burden, coping, personal history, and work) scores with gestational age. Higher scores on the instrument’s racism subscale—which assesses experience/perception of racial stereotypes, White privilege, and the impact of racism on Black children’s lives—were associated with increased probability of sPTB, but not sETB, as compared to term birth.
In Aim 3, we examined the association of gendered racial stress with C-reactive protein (CRP), an inflammatory biomarker. Median CRP was above previously published thresholds for sub-clinical inflammation. There was a null relationship between exposure to gendered racial stress and elevated CRP, with no moderation by education or body mass index.
Gendered racial stress may exist on a trajectory extending from a woman’s childhood to the wellbeing of her offspring. Though limited by sample size, these studies are an important step toward characterizing gendered racial stress pathways among pregnant Black women. Future population-based investigation may further clarify the etiology and embodiment of gendered racial stress over the lifecourse.
Table of Contents
Chapter 1: Public Health Significance and Literature Review.. 1
Public Health Significance. 2
Literature Review.. 3
Chapter 2: Overview of Specific Aims and Data Source. 22
Overview.. 23
Specific Aims. 26
Study Population. 27
Key Variables. 28
Chapter 3: The association of early life adversity with gendered racial stress among pregnant Black women. 34
Introduction. 35
Methods. 38
Participants. 38
Measures. 38
Statistical Analysis. 41
Results. 42
Discussion. 44
Limitations. 48
Conclusions. 49
Chapter 4: The association of maternal gendered racial stress with gestational age at birth among pregnant Black women. 59
Introduction. 60
Methods. 63
Participants. 63
Measures. 64
Statistical Analysis. 67
Results. 69
Discussion. 71
Limitations. 75
Conclusions. 76
Appendix. 84
Chapter 5: The association of gendered racial stress with C-reactive protein among Black women in early pregnancy. 88
Introduction. 89
Methods. 91
Participants. 91
Measures. 91
Statistical Analysis. 94
Results. 95
Discussion. 95
Limitations. 97
Conclusion. 97
Appendix. 102
Chapter 6: Conclusion. 107
Summary of Findings. 107
Strengths and Limitations. 108
Future Research. 109
References. 110
About this Dissertation
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