Gendered Racism Profiles, Resilience, and High-Risk Pregnancies Among Black Women

摘要。美国黑人女性死于怀孕的可能性是黑人女性的三到四倍， 与白色妇女相比，相关原因的比例更高，这种差距在过去五十年中一直存在。妊娠 妊娠期糖尿病（GDM）和妊娠期高血压疾病（HDP）在妊娠期不成比例地发生 对黑人妇女的心脏代谢健康产生负面影响。性别 种族主义是种族主义和性别歧视的混合现象，相互交织，形成一种独特的压迫形式， 黑人妇女所经历的慢性压力源，导致了持续的健康差距。但 关于性别种族主义对健康的影响的经验证据仍然刚刚出现。心理韧性 被发现可以防止不良的怀孕结果，但黑人妇女从这种弹性中受益较少 资产一个更具文化相关性的理解弹性纳入个人层面（心理 韧性和灵性）和家庭层面（家庭支持）将在本研究中进行探讨。总的目的 这项研究的目的是研究性别种族主义经历，弹性和高风险之间的关系。 黑人妇女怀孕。国家青少年至成人健康纵向研究的数据将 用于评估黑人妇女的性别种族主义，高风险怀孕和弹性的经验 至少有一次妊娠（N = 2，153）。目标是：目标1。确定潜在的女性亚群， 通过四个指标（结构性性别歧视，人际性别歧视， 结构性种族主义和人际间种族主义）。目标2.确定高风险患者的病史 妊娠（GDM/HDP，病例与对照）与性别种族主义的经验特点，确定 潜在亚组，慢性高血压、糖尿病（1型或2型）、体重指数、 教育和收入。目标3.描述高危妊娠史与性别 种族主义经历与复原力来源（个人和家庭）在成年期， 高血压、糖尿病（1型或2型）、体重指数、教育水平和收入。潜剖面分析 将用于确定具有不同性别种族主义经历的黑人妇女的亚组。双变量和 将使用协变量调整的多项逻辑回归方法来确定相关性 高风险怀孕和性别种族主义亚组经历之间的关系。协变量调整倍数 本研究将进行回归分析，以探讨高风险妊娠与性别种族主义亚群的关系 体验韧性。本研究采用了一种创新的方法论， 人际和结构性的性别种族主义，以量化压迫的多方面性质， 黑人女性沿着与文化相关的弹性概念。研究结果将提高 了解性别种族主义的健康后果，并为今后的多层次研究提供信息。 采取干预措施，消除系统性不平等，增强复原力。

ABSTRACT. Black women in the United States are three to four times more likely to die from pregnancy- related causes than White women, a disparity that has persisted for the past five decades. Gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) disproportionately develop in the pregnancies of Black women and negatively impact cardiometabolic health in the years following pregnancy. Gendered racism, a hybrid phenomenon of racism and sexism that interlocks to create a unique form of oppression, is a chronic stressor experienced by Black women and contributes to ongoing health disparities. However, the empirical evidence on the health implications of gendered racism is still nascent. Psychological resilience has been found to protect against adverse pregnancy outcomes, yet Black women benefit less from such resilience assets. A more culturally relevant understanding of resilience incorporating the individual-level (psychological resilience and spirituality) and family-level (family support) will be explored in this study. The overall purpose of this study is to examine the relationships between gendered racism experiences, resilience, and high-risk pregnancies among Black women. Data from the National Longitudinal Study of Adolescent to Adult Health will be used to assess experiences of gendered racism, high-risk pregnancy, and resilience among Black women with at least one pregnancy (N = 2,153). The aims are to: Aim 1. Identify latent subgroups of women with different gendered racism experiences determined by four indicators (structural sexism, interpersonal sexism, structural racism, and interpersonal racism). Aim 2. Determine the relationship of history of a high-risk pregnancy (GDM/HDP, cases vs controls) with gendered racism experiences characterizing the identified latent subgroups, covarying for chronic hypertension, diabetes (type 1 or 2), body mass index, level of education, and income. Aim 3. Describe the association of history of a high-risk pregnancy and gendered racism experiences with sources of resilience (individual and family) during adulthood, covarying for chronic hypertension, diabetes (type 1 or 2), body mass index, level of education, and income. Latent profile analysis will be used to identify subgroups for Black women with different gendered racism experiences. Bivariate and covariate-adjusted multinominal logistic regression approach will be used to determine the association between high-risk pregnancy and gendered racism subgroup experiences. Covariate-adjusted multiple regression will be conducted to examine the relationship of high-risk pregnancy and gendered racism subgroup experiences with resilience. This study uses an innovative methodological approach that integrates both interpersonal and structural gendered racism to quantity the multifaceted nature of oppression experienced by Black women along with a culturally relevant conceptualization of resilience. The findings will enhance the understanding of the health consequences of gendered racism and inform future research on multi-level interventions to combat systemic inequalities and foster resilience.