Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk

Summary Racism is under scrutiny as a fundamental cause of racial-ethnic inequity in maternal morbidity and mortality, and now, the COVID-19 pandemic is replicating existing structures of inequality and disproportionately harming communities of color. Current evidence on racism in birthing people centers around birth outcomes, with little known of its influence on maternal postpartum health, when racial-ethnic disparities in maternal mortality are widest. Thus, it is urgent to investigate the influence of racism on postpartum maternal morbidity during the COVID-19 pandemic. To fill this gap, we propose a prospective postpartum cohort examining the influence of exposure to structural and interpersonal racism and the COVID-19 pandemic on postpartum maternal health. This goal aligns with that of the parent R01, to identify high-risk women in the postpartum period and design and implement a behavioral educational intervention to reduce inequity in maternal mortality and morbidity. We will recruit a postpartum cohort of 400 multiethnic mothers in Philadelphia and New York City. Our primary aim is to assess multiple levels of racism using contextual and self-reported measures at delivery, then prospectively follow postpartum patients three months to assess blood pressure (BP) trajectories, anxiety, depression, and quality of life among. Our second aim is to explore associations between COVID-19 exposures, including infection or social and economic stress, and postpartum maternal morbidity outcomes. Finally, we will test if individual or community resilience buffers associations between racism and postpartum maternal morbidity. The proposed study will provide new evidence of the influence of perceived and structural racism on postpartum maternal morbidity, with a focus on outcomes with strong ties to maternal mortality. Our findings will be used to target exposure to racism as a driver of maternal morbidity and resilience as a modifiable buffer in the design of a multilevel intervention to reduce maternal mortality.