Physiological mechanisms mediating socio-environmental influences on pregnancy outcomes in Black people

Black women and their infants experience higher mortality rates than their White counterparts. While systemic racism, socioeconomic disadvantage, and environmental stressors are recognized contributors, physiological pathways that mediate their effects on health disparities remain poorly understood. This review explores mechanisms through which stress-related epigenetic processes may contribute to more adverse pregnancy outcomes in Black women. Increased uteroplacental vascular resistance, oxidative stress, and inflammation are established mechanisms associated with leading causes of maternal and infant mortality, but there are differences in the expression of these mechanisms between Black and White women. We propose that these differences, which may reflect differences in social and environmental exposures, can help to explain the disparity in maternal and infant mortality rates between Black and White people.