Advancing understanding of racism-related health disparities beginning before birth: A multisite study with Black and Latina pregnant women

描述性标题：增进对与种族主义有关的出生前健康差距的理解 项目摘要/摘要 种族和族裔不公正是造成压力和随后的健康差距的普遍和破坏性原因。 黑人和拉丁裔妇女经历了更高的怀孕并发症负担、孕产妇死亡率和 与白人妇女相比，早产。这些出生结果的差异因生育制度而加剧 忽视或使有色人种孕妇的经历无效，导致高危分娩的护理， 不必要的产科干预以及妇女和婴儿的死亡。然而，还没有研究检验是否 种族主义经历通过一种“生物学”过程影响胎儿的健康和发育 在怀孕期间每天测量的种族主义“嵌入”。这项研究将解决文献中的三个主要空白 到目前为止。首先，种族主义和歧视的经历往往是在全球范围内衡量的，没有累积 应激暴露对胎儿生理发育的影响。其次，目前还不清楚具体的合作伙伴 行为(例如，确认与种族主义有关的经历)和/或基于文化的应对策略 在激进的治疗框架中(例如，种族/民族认同、激进主义)可以缓冲种族主义对母亲的影响 生理学、胎儿生理学和分娩结局。第三，考虑到这个研究项目的新颖性，它很重要 在这场变革中，整合以黑人和拉丁裔女性经历为中心的定性方法 和脆弱的生命阶段。这项建议的目的是增进对与种族主义有关的了解 孕妇和婴儿的健康差异：(1)在第二年和第二年期间招募黑人和拉丁裔妇女 怀孕晚期，通过每日日记评估评估日常种族主义经历(14 连续几天妊娠)；(2)在妊娠第三个月期间测量母亲和胎儿的心理生理(例如， 心率、心率变异性)；(3)在出生48小时内评估新生儿神经发育；以及(4) 探索以文化为基础的缓冲和对妇女和婴儿的种族主义的定性经验。我们将招收 来自佐治亚州亚特兰大和德克萨斯州盐湖城的400名孕妇(n=200个/站点)，使用已建立的 在这一发展阶段招募和留住妇女的方案。参赛的女性将完成 调查问卷和两周的每日日记，记录孕期第二和第三个月与种族主义有关的压力源。在第三节 三个月后，妇女将完成这些措施，一次定性访谈，以及两周的居家产妇和 胎儿生理测量，包括对胎儿心率(HR)和心率变异性的创新测量 (HRV)。女性还会与她们的浪漫伴侣或最亲密的支持完成一项有条理的互动任务 个人；讨论每个人如何应对与种族主义有关的压力源。在出生后48小时内，婴儿 将完成NICU网络神经行为量表(NNNS)，以评估产前暴露于种族主义可能 会影响新生儿的出生结果。这项短期的纵向研究为进一步的后续研究奠定了基础 婴幼儿和妇女进入幼儿期，以及致力于理解和 与边缘化的母亲和儿童进行干预，以减少种族主义对家庭健康和福祉的影响。

Descriptive Title: Advancing understanding of racism-related health disparities before birth Project Summary/Abstract Racial and ethnic injustice are prevalent and devastating causes of stress and subsequent health disparities. Black and Latina women experience a higher burden of pregnancy complications, maternal mortality, and preterm birth compared to White women. These disparities in birth outcomes are exacerbated by systems of care that neglect or invalidate the experiences of pregnant women of color, contributing to high-risk deliveries, unnecessary obstetric interventions, and death of women and infants. Yet, no studies have examined whether experiences of racism prenatally affect fetal health and development through a process of “biological embedding” of racism measured daily during pregnancy. This study will address three major gaps in the literature to date. First, experiences of racism and discrimination are often measured globally, missing the cumulative nature of stress exposure on fetal physiological development. Second, it is unclear whether specific partner behaviors (e.g., validation of racism-related experiences) and/or culturally-grounded coping strategies grounded in the Radical Healing Framework (e.g., racial/ethnic identity, activism) can buffer effects of racism on maternal physiology, fetal physiology, and birth outcomes. Third, given the novelty of this research program, it is important to integrate qualitative methods that center the experiences of Black and Latina women during this transformative and vulnerable life stage. The objective of this proposal is to advance understanding of racism-related health disparities in pregnant women and infants by (1) enrolling Black and Latina women during the 2nd and 3rd trimester of pregnancy and assessing daily racism experiences through daily diary assessments (14 consecutive days trimester); (2) measuring maternal and fetal psychophysiology during the third trimester (e.g., heart rate, heart rate variability); (3) assessing newborn neurodevelopment within 48 hours of birth; and (4) exploring culturally-grounded buffers and qualitative experiences of racism on women and infants. We will enroll 400 pregnant women from the Atlanta, GA and Salt Lake City, UT metro areas (n=200/site), using established protocols for recruiting and retaining women during this developmental stage. Participating women will complete questionnaires and a 2-week daily diary of stressors related to racism in the 2nd and 3rd trimester. In the 3rd trimester, women will complete these measures, a qualitative interview, and two weeks of in-home maternal and fetal physiological measures, which includes an innovative measure of fetal heart rate (HR) and HR variability (HRV). Women will also complete a structured interaction task with their romantic partner or closest support person; involving discussions of how each cope with racism-related stressors. Within 48 hours of birth, infants will complete the NICU Network Neurobehavioral Scale (NNNS) to assess how prenatal exposure to racism may affect newborn birth outcomes. This short-term longitudinal study lays the foundation for further follow-up of infants and women into early childhood and a programmatic line of research devoted to understanding and intervening with marginalized mothers and children to reduce the effects of racism on family health and wellbeing.