Social
Association between discrimination and spontaneous abortion in a preconception cohort Sharonda M. Lovett* Sharonda M. Lovett Lauren A. Wise Jasmine Abrams Molly N. Hoffman Chad M. Coleman Ruth J. Geller Renée Boynton-Jarrett Collette N. Ncube
Introduction: Discrimination may increase risk of spontaneous abortion (SAB, pregnancy loss <20 weeks’ gestation) via pathways such as heightened stress, limited access to societal resources, and exposure to adverse environments.
Methods: We examined associations of discrimination with SAB incidence among 5,586 participants who conceived in Pregnancy Study Online, a preconception cohort study (2013-2023). Eligible participants were 21-45 years, assigned female sex at birth, and U.S. or Canadian residents. We collected data on pregnancies and SABs at baseline and follow-up. Starting in 2019, we invited participants to recall discriminatory experiences using Williams’ Everyday Discrimination and Major Experiences of Discrimination scales. We used age and race/ethnicity-adjusted Cox models to estimate hazard ratios (HR) and 95% CIs with gestational weeks as the time scale. We also explored effect modification by race/ethnicity.
Results: Seventeen percent of participants reported very high scores of everyday discrimination and 47% reported ≥1 event of lifetime discrimination. Job discrimination was the most prevalent lifetime experience (34%) while the most prevalent everyday experiences included others perceiving the participant as not smart (64%) and being treated with disrespect (63%). Everyday discrimination was positively associated with SAB. Relative to no everyday discrimination, HRs for low, medium, high, and very high scores of everyday discrimination were 1.11 (CI 0.90-1.37), 0.93 (CI 0.76-1.15), 1.13 (CI 0.91-1.39), and 1.20 (CI 0.97-1.49), respectively. Lifetime discrimination was also associated with higher SAB incidence (1 event: HR=1.02, CI 0.86-1.20, ≥2 events: HR=1.24, CI 1.07-1.45 vs. none). HRs for everyday discrimination, but not lifetime discrimination, were similar across race/ethnicity strata.
Conclusions: This is the first study of discrimination and SAB. Our findings suggest everyday and lifetime discrimination are associated with SAB incidence.