Descriptive Title: Advancing understanding of racism-related health disparities before birth Project Summary/Abstract Racial and ethnic injustice are prevalent and devastating causes of stress and subsequent health disparities. Black and Latina women experience a higher burden of pregnancy complications, maternal mortality, and preterm birth compared to White women. These disparities in birth outcomes are exacerbated by systems of care that neglect or invalidate the experiences of pregnant women of color, contributing to high-risk deliveries, unnecessary obstetric interventions, and death of women and infants. Yet, no studies have examined whether experiences of racism prenatally affect fetal health and development through a process of “biological embedding” of racism measured daily during pregnancy. This study will address three major gaps in the literature to date. First, experiences of racism and discrimination are often measured globally, missing the cumulative nature of stress exposure on fetal physiological development. Second, it is unclear whether specific partner behaviors (e.g., validation of racism-related experiences) and/or culturally-grounded coping strategies grounded in the Radical Healing Framework (e.g., racial/ethnic identity, activism) can buffer effects of racism on maternal physiology, fetal physiology, and birth outcomes. Third, given the novelty of this research program, it is important to integrate qualitative methods that center the experiences of Black and Latina women during this transformative and vulnerable life stage. The objective of this proposal is to advance understanding of racism-related health disparities in pregnant women and infants by (1) enrolling Black and Latina women during the 2nd and 3rd trimester of pregnancy and assessing daily racism experiences through daily diary assessments (14 consecutive days trimester); (2) measuring maternal and fetal psychophysiology during the third trimester (e.g., heart rate, heart rate variability); (3) assessing newborn neurodevelopment within 48 hours of birth; and (4) exploring culturally-grounded buffers and qualitative experiences of racism on women and infants. We will enroll 400 pregnant women from the Atlanta, GA and Salt Lake City, UT metro areas (n=200/site), using established protocols for recruiting and retaining women during this developmental stage. Participating women will complete questionnaires and a 2-week daily diary of stressors related to racism in the 2nd and 3rd trimester. In the 3rd trimester, women will complete these measures, a qualitative interview, and two weeks of in-home maternal and fetal physiological measures, which includes an innovative measure of fetal heart rate (HR) and HR variability (HRV). Women will also complete a structured interaction task with their romantic partner or closest support person; involving discussions of how each cope with racism-related stressors. Within 48 hours of birth, infants will complete the NICU Network Neurobehavioral Scale (NNNS) to assess how prenatal exposure to racism may affect newborn birth outcomes. This short-term longitudinal study lays the foundation for further follow-up of infants and women into early childhood and a programmatic line of research devoted to understanding and intervening with marginalized mothers and children to reduce the effects of racism on family health and wellbeing.

PROJECT NARRATIVE Black and Latina women experience a higher burden of pregnancy complications, maternal mortality, and preterm birth compared to white women due to the significant impact of racism and racialized inequity. Yet, no studies have examined whether experiences of racism prenatally affect fetal health and development through a process of “biological embedding” of racism measured daily during pregnancy. The proposed multi-site and rigorously-designed longitudinal research aims to advance understanding of racism-related health disparities as well as modifiable stress-buffering factors in pregnant Black and Latina women and infants.