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

描述性标题：提高对出生前种族主义相关健康差异的理解 项目总结/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毁灭性的原因。 黑人和拉丁裔妇女在怀孕并发症、孕产妇死亡率和 与白色女性相比早产。生育结果的这些差异因生育制度而加剧。 护理忽视或无效的有色人种孕妇的经验，有助于高风险分娩， 不必要的产科干预以及妇女和婴儿的死亡。然而，没有研究调查是否 产前种族主义的经历通过“生物学”过程影响胎儿的健康和发育， 在怀孕期间每天测量种族主义的“嵌入”。本研究将解决文献中的三个主要空白 迄今首先，种族主义和歧视的经历往往是全球衡量的，而忽略了累积的 应激暴露对胎儿生理发育的影响。其次，不清楚具体合作伙伴是否 行为（例如，种族主义相关经历的确认）和/或基于文化的应对战略 在激进的治疗框架中（例如，种族/民族认同、行动主义）可以缓冲种族主义对孕产妇的影响， 生理学、胎儿生理学和分娩结果。第三，鉴于这项研究计划的新奇， 整合定性方法，集中在黑人和拉丁裔妇女的经验，在这一变革 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 孕妇和婴儿的健康差异，方法是：（1）在第二阶段招收黑人和拉丁裔妇女， 怀孕第三个三个月，并通过每日日记评估评估每日种族主义经历（14 三个月的连续天数）;（2）在三个月的最后三个月期间测量母亲和胎儿的心理生理学（例如， 心率、心率变异性）;（3）评估出生48小时内的新生儿神经发育;以及（4） 探索基于文化的缓冲区和妇女和婴儿遭受种族主义的定性经历。我们将招收 来自佐治亚州亚特兰大和犹他州湖城区的400名孕妇（n=200/研究中心），使用已建立的 在这个发展阶段招募和留住女性的协议。参与的妇女将完成 调查问卷和2周的日记与种族主义有关的压力源在第二和第三个三个月。第3 三个月，妇女将完成这些措施，定性访谈，和两个星期的家庭产妇和 胎儿生理测量，包括胎儿心率（HR）和HR变异性的创新测量 （HRV）。女性也会和她们的浪漫伴侣或最亲密的支持者一起完成一个结构化的互动任务 人;涉及如何科普与种族主义有关的压力的讨论。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如何可能 影响新生儿的出生结果。这项短期纵向研究为进一步跟踪 婴儿和妇女进入幼儿期，以及一系列致力于了解和 对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.