# Does self-reported psychosocial stress in pregnancy mediate the association between maternal race/ethnicity and hypertensive disorders of pregnancy?

> **NIH NIH F31** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $48,214

## Abstract

PROJECT SUMMARY/ABSTRACT
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in the
United States (US). HDP (e.g., preeclampsia) present a cascade of health issues for pregnant persons and
fetuses. While HDP are not rare in the US (affecting approximately 1 in 12 women), Black women face unique
risks and challenges regarding HDP and pregnancy-related mortality (PRM). HDP are more prevalent among
Black than White women. Black women also experience more severe HDP than White women. Further, Black
women experience the highest rate of pregnancy-related deaths: 41 vs. 16.7/100,000 births in the overall
US. Pregnancy-related racial/ethnic disparities persist over time across age groups and groups with higher
levels of education. There is no evidence to suggest that genetic or other inherent differences by race/ethnicity
explain these disparities; race/ethnicity instead are suggested to represent an amalgam of individuals' social,
cultural, political, and economic experiences throughout the life course. Given that pregnancy is also a critical
period in the life course, the psychosocial environment during pregnancy is suggested to impact physiologic
pathways involved in obstetric and perinatal health. However, the pathways by which the psychosocial
environment influence racial/ethnic differences in maternal health outcomes remain unknown. One explanation
for these disparities is the experience of psychosocial stress, evidenced by higher mean allostatic load scores
among Black women due to psychosocial stress. Therefore, psychosocial stress in pregnancy is a plausible
mediator contributing to racial/ethnic pregnancy disparities. Using a nested case-control design with data from
a racially diverse cohort, the NICHD-Nulliparous Mothers To Be Study (nuMoM2b), this proposal will assess
whether the effect of self-reported race/ethnicity on HDP is partially mediated by psychosocial stress in
pregnancy. This study will also explore if the mediated pathway is moderated by social support during
pregnancy. Social support is conjectured to function as a coping mechanism that helps individuals overcome
psychosocial stress. Study aims are to (1-2D) examine the total effects of self-reported maternal race/ethnicity
and HDP, including the indirect effect through a mediated pathway via psychosocial stress, and (3) evaluate if
perceived social support modifies the partially mediated models. This study will go beyond the traditional
approach in the literature of describing differences between groups and instead propose that the social
construct of race/ethnicity represents the cumulative lived experiences of individuals belonging to a specific
racial/ethnic group. Execution of these specific aims will advance the NICHD mission to understand human
development, improve reproductive health, enhance the lives of children and adolescents, and optimize
abilities for all. Specifically, by elucidating possible causal pathways to reduce...

## Key facts

- **NIH application ID:** 11105757
- **Project number:** 5F31HD110257-02
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Autumn M Clemons
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $48,214
- **Award type:** 5
- **Project period:** 2023-09-01 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11105757

## Citation

> US National Institutes of Health, RePORTER application 11105757, Does self-reported psychosocial stress in pregnancy mediate the association between maternal race/ethnicity and hypertensive disorders of pregnancy? (5F31HD110257-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/11105757. Licensed CC0.

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