Experiences of Racism and Risk of Preeclampsia in the Black Women’s Health Study

BACKGROUND: Black women in the United States experience higher rates of preeclampsia incidence, severity, and case fatality than White women, which contributes to cardiovascular disease disparities. Differences in cardiometabolic risk factors do not fully explain this disparity, and there is growing consensus that racism may be a root cause. Few studies have evaluated associations between racism and preeclampsia among cohorts of exclusively Black women. METHODS: We analyzed data from the Black Women's Health Study, a follow-up study of ≈59 000 Black women in the United States established in 1995. We included women who were nulliparous at the time of enrollment and had their first birth from 1995 through 2009. Racism was measured as a total daily racism score (reported as daily exposure to interpersonal racism) and an institutional racism summary score (reported as ever being treated unfairly due to race with respect to police, housing, or on the job). We used logistic regression models adjusted for demographic, reproductive, and health factors to estimate odds ratios and 95% CIs. RESULTS: Women in the highest quartile of daily racism had a 50% higher odds of preeclampsia compared with those in the lowest quartile (adjusted odds ratio, 1.50 [95% CI, 1.13-1.99]). Women reporting institutional racism in 2 domains had 47% higher odds compared with those reporting none (adjusted odds ratio, 1.47 [95% CI, 1.14-1.91]). CONCLUSIONS: Greater experiences of daily and institutional racism were associated with an increased risk of preeclampsia, suggesting that racism contributes to the disproportionate burden of preeclampsia among Black women in the United States.