The impact of structural racism and discrimination on perinatal health during the COVID-19 pandemic

1 Exposure to psychosocial stress during pregnancy and the postpartum period is linked to poor outcomes, 2 including preterm birth and increased risk of perinatal mood disorders. Early evidence from our work and that 3 of others suggests that pregnant and postpartum individuals have been particularly vulnerable to the inequities, 4 challenges, hardship, isolation, and stressors of the recent COVID-19 pandemic, especially those who are non- 5 White and of lower socioeconomic status (SES). These pandemic-related disparities are thought to reflect the 6 influence structural racism and discrimination (SRD), which manifests in the lives of individuals via 7 neighborhood poverty, disinvestment, violence, segregation, and over-policing. Along with discriminatory 8 practices in educational and workplace settings, these forces have long been known to impair human capital 9 formation and constrain social mobility. Recent evidence from our work and that of others suggests that facets 10 of SRD may also increase stress, worsen mental health, and heighten risk for adverse perinatal outcomes 11 including preterm delivery, and small for gestational age birth. How SRD "gets under the skin" is poorly 12 understood, but converging evidence suggests the hypothesis that it engenders a pro-inflammatory phenotype, 13 with implications for mother's psychiatric and perinatal health, and conceivably the well-being of their offspring. 14 The guiding premise of this proposal is that the hardships associated with the COVID pandemic have 15 exacerbated the detrimental influence that SRD already has on the health of pregnant and postpartum 16 individuals. Drawing on two ongoing R01 studies from our multidisciplinary team (SPAH: Chicago, IL and 17 PIINC: Greenvillle, SC), we propose an administrative supplement to evaluate this hypothesis. These studies 18 include extensive data on life stress, mental health, and inflammation in multiple compartments. Altogether, 19 they include 1750 demographically and geographically diverse participants, 330 of whom completed their 20 assessments during the pandemic. These large and well-characterized samples provide a unique opportunity 21 to consider how existing SRD and pandemic-related hardships have affected the health of pregnant and 22 postpartum individuals separately and synergistically, and variably by geography. Specifically, we aim (1) to 23 identify how exposure to the hardships of the COVID19 pandemic has impacted disparities in perinatal mental 24 health; (2) to identify whether a multilevel inflammatory phenotype manifesting at the genomic, cellular, and 25 systemic levels explains the synergistic effect of COVID19 and SRD on perinatal mental health; and (3) to 26 identify how exposure to the hardship of the COVID19 pandemic and SRD has impacted disparities in perinatal 27 outcomes. By generating geocoded measures of SRD and characterizing pregnancy inflammation at the 28 genomic, cellular, and systemic levels, this innovative project will use an integrative conceptual framework to 29 assess health equity at the structural level and reveal possible opportunities to reduce the disproportionate 30 impact of the COVID19 pandemic on vulnerable communities.