Beyond Black and White: Understanding Skin Tone as a Driver of Prepregnancy Cardiometabolic Health and Birth Outcomes

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ABSTRACT—Despite an overall improvement in birth outcomes, racial disparities persist in the United States, (US). Moreover, Black women remain at a higher risk of having poor pregnancy outcomes even after controlling for traditional risk factors such socioeconomic status, health behaviors and chronic comorbidities. Though researchers have broadened their lens to look beyond behavioral and biomedical determinants of health and consider racism as a fundamental determinant, most of the biomedical research overlooks the multidimensional nature of race and remains focused on inter-group (Black vs. White) comparisons. Failure to rigorously and comprehensively consider the intersectionality of race and its intersection with skin color, a proxy for colorism, has limited our understanding of the etiology of racial health disparities, including those in perinatal health. To our knowledge there has been no research specifically aimed at understanding how skin color variation, independent of race, influences maternal prepregnancy health, psychosocial exposures, and subsequent pregnancy outcomes. The goal of this proposed project is to investigate the salience of skin color in relation to the prepregnancy cardiometabolic health and subsequent birth outcomes of Black women using data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We will apply and intersectional lens to investigate the salience of skin color in relation to both in-group (e.g. within Blacks) and between-group (e.g. Black-White) heterogeneity. We will also explore skin color in relation to Black women’s psychosocial environment, since skin color may shape maternal health outcomes via 1) exposure to chronic and racism- related stress; 2) personal resilience resources (e.g. mastery and optimism) that may buffer against stress exposure; and 3) allocation of health promoting socioeconomic resources. This study provides a unique opportunity to consider how race, skin color, and socioeconomic status (SES) shape women’s prepregnancy cardiometabolic health, possible mediating psychosocial factors, and birth outcomes. Findings from this study will be used as preliminary data for a future NIH grant proposal to extend research on the intersectionality of race, skin color, and SES in relation to women’s pregnancy outcomes and cardiometabolic health.