Black women have the highest rates of maternal morbidity and mortality in the US. Maternal mortality is 3-4 times higher among Black women than White women (42 vs 13/ 100,000 live births). While deaths during pregnancy and the postpartum period can be linked to direct causes, such as cardiovascular events, infections, and hemorrhage, we must investigate factors further upstream if we are to reduce maternal mortality. Using a life course framework for perinatal health, we propose to study Black women?s lifetime trauma as an antecedent to the increased risks of maternal morbidity that underly maternal mortality. Lifetime trauma due to exposures to racism, living in neighborhoods with higher levels of disorder (e.g., vacant houses) and crime, and socioeconomic adversities throughout their lives may increase risk for maternal morbidity for Black women including pregnancy-related complications (e.g., preeclampsia), infections, cardiovascular disease and depressive symptoms. Shorter telomere length (TL), a biological measure of chronic stress, relates to racism, neighborhood disorder, and socioeconomic adversities; and increases the risk for depressive symptoms and cardiovascular. Lifetime trauma has also been related to greater systemic inflammation [e.g., higher levels of pro-inflammatory cytokines and C-Reactive Protein (CRP)] among Blacks. Our hypothesis is that lifetime trauma (measured by women?s reports and shorter TL) relates to higher risk for maternal morbidity; systemic inflammation mediates this association. The goal of this supplemental study is to examine the association of lifetime trauma with maternal morbidity among Black women, and whether alterations in systemic inflammation mediate this association. Our cohort is comprised of 658 pregnant Black women from the Detroit, MI and Columbus, OH areas. Women completed questionnaires about their experiences during childhood (age 10 as reference) and during pregnancy including racism, neighborhood disorder and crime, and socioeconomic adversity. Depressive symptoms during pregnancy were also measured. Women had blood drawn for cytokines and CRP analysis and saliva collected for TL. Obstetrical and medical history were abstracted from maternal medical records. For this supplemental study, we will use a global measure of maternal morbidity (e.g., preeclampsia, infections, cardiovascular conditions, depressive symptoms). We will link Medicaid claims data with our medical records abstraction data to ensure a comprehensive account of maternal morbidity for women during their pregnancy and within 1 year after birth.
We aim to: (1) Examine the association of maternal morbidity with lifetime trauma (1a, women?s reports of lifetime trauma; 1b, TL); and (2) Examine the associations of systemic inflammation with lifetime trauma and maternal morbidity. This study will provide preliminary data for a larger study to examine the role of lifetime trauma on maternal morbidity among Black women.
Black women have the highest rates of maternal morbidity and mortality in the US -- 3-4 times higher than White women. Lifetime trauma due to exposures to racism, living in neighborhoods with disorder and crime, and socioeconomic adversities throughout Black women?s lives may increase risk for maternal morbidity for Black women. This supplemental study will provide preliminary data for a larger study that will examine the role lifetime trauma has on maternal morbidity among Black women.
