Gendered Racism in Pregnancy and Stress among Women in the United States during the COVID-19 Pandemic.

High stress experienced during pregnancy increases risk for adverse birth outcomes such as low birthweight and preterm birth that occur disproportionately among women of color in the United States. Prior research has identified a distinct form of discrimination, gendered racism in pregnancy (GRiP), that likely elevates stress and is suspected to contribute to racial disparities in birth outcomes among American women. We investigated associations of GRiP experiences and distress with two types of stress, pregnancy related and pandemic related, among 2,995 women in the U.S. pregnant at the height of the COVID-19 pandemic, a time when health care restrictions, social contact limitations, and concerns about COVID-19 infection created added stress for pregnant women. Using data collected online during the second U.S. pandemic surge (December 2020), we found that pregnant self-identified Hispanic/Latina (n = 233), Non-Hispanic/Latina Black/African American (n = 182), and Multiracial/Other (n =201) women experienced greater GRiP and greater stress of both types than Non-Hispanic/Latina White women. Structural equation modeling indicated a strong association of racial/ethnic identity with prenatal stress that was mediated by GRiP, independent of other contributors to prenatal stress. Focusing on the harmful impact of gendered racism coupled with culturally-informed individual interventions and change at multiple societal levels and institutions may help reduce the poorer reproductive outcomes that are disproportionately common among communities of color in the U.S. Addressing and alleviating discrimination can improve reproductive justice for all who choose to give birth throughout the world, regardless of their race, ethnicity, nationality, or other identities.