The impact of structural racism and discrimination on perinatal health during the COVID-19 pandemic

1怀孕期间和产后期间暴露于心理社会压力与不良结局有关， 2包括早产和围产期情绪障碍的风险增加。我们工作的早期证据 其他3人认为，怀孕和产后的人特别容易受到不公平的影响， 最近COVID-19大流行的4个挑战、困难、孤立和压力因素，特别是那些非 5白色和社会经济地位较低的人。这些与流行病有关的差异被认为反映了 6影响结构性种族主义和歧视（SRD），这表现在个人的生活中， 7邻里贫困，撤资，暴力，隔离和过度监管。沿着歧视性 8在教育和工作场所环境中的做法，这些力量长期以来一直被认为会损害人力资本 9、限制社会流动。我们和其他人的工作中最近的证据表明， 10的SRD也可能增加压力，恶化心理健康，并增加不良围产期结局的风险 11例包括早产和小于胎龄儿出生。SRD如何“进入皮肤”是很差的 12理解，但汇集的证据表明，它产生了促炎表型的假设， 13与母亲的精神和围产期健康的影响，可以想象的是，他们的后代的福祉。 14本提案的指导前提是，与COVID大流行相关的困难已经 15加剧了SRD已经对孕妇和产后妇女健康的不利影响。 16个人根据我们的多学科团队（SPAH：芝加哥，IL和 17 PIINC：Greenvillle，SC），我们提出了一个行政补充来评估这一假设。这些研究 18包括关于生活压力，心理健康和多个隔室炎症的广泛数据。总之， 19他们包括1750名人口统计和地理分布不同的参与者，其中330人完成了他们的 大流行期间进行了20次评估。这些大型且特征良好的样本提供了一个独特的机会 21审议现有的性传播疾病和与流行病有关的困难如何影响孕妇和 22个产后个体分别和协同，并按地理位置分类。具体而言，我们的目标是（1） 23确定暴露于COVID 19大流行的困难如何影响围产期心理差异 24健康;（2）确定是否存在多层次的炎症表型，表现在基因组、细胞和组织中。 25个系统水平解释了COVID 19和SRD对围产期心理健康的协同作用;以及（3） 26确定暴露于COVID 19大流行和SRD的困难如何影响围产期差异 27个结果通过生成SRD的地理编码测量值并表征妊娠炎症， 28个基因组，细胞和系统水平，这个创新项目将使用一个综合的概念框架， 29.评估结构层面的卫生公平性，并揭示减少不成比例的 30 COVID 19大流行对弱势社区的影响。

1 Exposure to psychosocial stress during pregnancy and the postpartum period is linked to poor outcomes, 2 including preterm birth and increased risk of perinatal mood disorders. Early evidence from our work and that 3 of others suggests that pregnant and postpartum individuals have been particularly vulnerable to the inequities, 4 challenges, hardship, isolation, and stressors of the recent COVID-19 pandemic, especially those who are non- 5 White and of lower socioeconomic status (SES). These pandemic-related disparities are thought to reflect the 6 influence structural racism and discrimination (SRD), which manifests in the lives of individuals via 7 neighborhood poverty, disinvestment, violence, segregation, and over-policing. Along with discriminatory 8 practices in educational and workplace settings, these forces have long been known to impair human capital 9 formation and constrain social mobility. Recent evidence from our work and that of others suggests that facets 10 of SRD may also increase stress, worsen mental health, and heighten risk for adverse perinatal outcomes 11 including preterm delivery, and small for gestational age birth. How SRD “gets under the skin” is poorly 12 understood, but converging evidence suggests the hypothesis that it engenders a pro-inflammatory phenotype, 13 with implications for mother’s psychiatric and perinatal health, and conceivably the well-being of their offspring. 14 The guiding premise of this proposal is that the hardships associated with the COVID pandemic have 15 exacerbated the detrimental influence that SRD already has on the health of pregnant and postpartum 16 individuals. Drawing on two ongoing R01 studies from our multidisciplinary team (SPAH: Chicago, IL and 17 PIINC: Greenvillle, SC), we propose an administrative supplement to evaluate this hypothesis. These studies 18 include extensive data on life stress, mental health, and inflammation in multiple compartments. Altogether, 19 they include 1750 demographically and geographically diverse participants, 330 of whom completed their 20 assessments during the pandemic. These large and well-characterized samples provide a unique opportunity 21 to consider how existing SRD and pandemic-related hardships have affected the health of pregnant and 22 postpartum individuals separately and synergistically, and variably by geography. Specifically, we aim (1) to 23 identify how exposure to the hardships of the COVID19 pandemic has impacted disparities in perinatal mental 24 health; (2) to identify whether a multilevel inflammatory phenotype manifesting at the genomic, cellular, and 25 systemic levels explains the synergistic effect of COVID19 and SRD on perinatal mental health; and (3) to 26 identify how exposure to the hardship of the COVID19 pandemic and SRD has impacted disparities in perinatal 27 outcomes. By generating geocoded measures of SRD and characterizing pregnancy inflammation at the 28 genomic, cellular, and systemic levels, this innovative project will use an integrative conceptual framework to 29 assess health equity at the structural level and reveal possible opportunities to reduce the disproportionate 30 impact of the COVID19 pandemic on vulnerable communities.