The impact of structural racism during pregnancy on future cardiopulmonary health

Project Summary Cardiovascular disease (CVD) is the leading cause of death in women in the United States, with profound racial-ethnic disparities present. Mounting evidence suggests that pregnancy is a key window when cardiovascular (CV) health is eroded, increasing future CVD risk. Further, the link between CV and lung health

is well-established, and the critical prenatal period may influence multiple future morbidities simultaneously. Exposure to place-based structural racism may result in a pro-inflammatory state during pregnancy and impair postpartum cardiopulmonary health (CV and lung health) setting the stage for future chronic disease risk. For

instance, evidence from our pregnancy cohort (Generation C) in NYC found that racial-economic segregation, a measure of place-based structural racism, was associated with preterm birth which separately has been linked to a life course two-fold risk of CVD and respiratory mortality. To better understand the effect of place-

based structural racism during pregnancy on future cardiopulmonary health, we propose Gen C Mamas, a mixed-method longitudinal study of 440 underrepresented and understudied Black, Hispanic, and Asian (Global Majority) women from the Generation C cohort, initially recruited during pregnancy in 2020-2022 in

New York City. We will use a framework that incorporates theories of structural racism, the life course model of multimorbidity, resilience, and weathering in our proposed Gen C Mamas study. First, we will assess the association between place-based structural racism and cardiopulmonary health (e.g., systolic and diastolic

blood pressure, lung function, and hemoglobin A1c) in 440 women measured at 3 and 5-years postpartum. Then we will leverage previously collected data to examine how mid-pregnancy inflammation is associated with place-based structural racism during pregnancy and cardiopulmonary health. Finally, we will select 30 women

from this subgroup and invite them to participate in Photovoice data collection. We will hold focus group sessions where participants will narrate the stories of their photo choices, and these stories will be analyzed for themes and then mapped to our theoretical framework. Our findings can be used to develop novel prevention

strategies that disrupt or mitigate structural racism during pregnancy. Because of the central role of inflammation in health, our findings may provide a model that can be extended to additional chronic conditions understudied in women.