Health Disparities
Investigating perceived stress as a partial mediator between race, racial discrimination, and HDP outcomes Autumn Clemons* Autumn Clemons Clemons Clemons Clemons Clemons Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
Background: Psychosocial stress is a risk factor for hypertensive disorders of pregnancy (HDP), yet its role in contributing to HDP racial disparities remains understudied. We examined whether perceived stress, a measure of psychosocial stress, partially mediated the associations between: 1) race and HDP among the total sample, and 2) racial discrimination and HDP among non-Hispanic (NH) Blacks.
Methods: Included were 6,289 nulliparous individuals with singleton pregnancies who self-identified as NH Black or NH White. Race (a proxy for racism) was the primary exposure. Self-reported racial discrimination (Experiences of Discrimination scale) was the exposure in the subset analysis. Perceived stress (Perceived Stress Scale) was evaluated as a mediator in both analyses. Outcomes, preeclampsia (PE) and new-onset gestational hypertension (GHTN), were analyzed separately. Causal mediation was evaluated using multivariable logistic regression.
Results: NH Black participants had higher rates of PE (12.3% vs. 8.7%, p < .001) and higher levels of perceived stress (67.4% vs. 47.6%, p 40% of NH Black participants. Racial discrimination was not associated with each HDP outcome, and no mediation was observed.
Conclusion: This modest mediation finding suggests that pathways beyond perceived stress warrant further investigation and highlight the importance of disaggregating HDP subtypes when evaluating underlying mechanisms.