Early Pregnancy Body Mass Index and Experiences of Gendered Racial Microaggressions in a Multiracial, Multiethnic...

Weight bias is a source of stigma in healthcare, and obesity is disproportionately prevalent among Black and Hispanic individuals of reproductive age. However, relationships between body size and other forms of discrimination in perinatal settings remain poorly understood. Our objective was to examine the association between body mass index (BMI) and gendered racial microaggressions (GRM)-everyday discriminatory experiences related to race and gender-during perinatal care.

We studied a prospective cohort of Asian, Black, and Hispanic ("Global Majority") individuals who gave birth in four New York City and Philadelphia hospitals from March 2022-March 2023. Early pregnancy BMI was ascertained from weight and height recorded at first prenatal visit. Participants completed the validated GRM Scale, adapted for perinatal context by a community working group, during the birth hospitalization. We examined mean ± standard deviation (SD) GRM Scale score by BMI class and measured associations between BMI and GRM using multivariable Tweedie regression.

Of 368 participants, 27.2% had normal weight (18.5 kg/m² ≤ BMI < 25), 29.9% overweight (25 ≤ BMI < 30), 32.6% class I-II obesity (30 ≤ BMI < 40), and 10.3% class III obesity (BMI ≥ 40). Thirty-seven percent of participants reported experiencing at least one instance of GRM during perinatal care. Mean ± SD GRM Scale score (higher = more frequent) increased with BMI class, from 1.7 ± 3.8 among those with normal weight to 4.8 ± 9.3 with class III obesity; associations persisted after adjusting for age, education, parity, and late prenatal care.

BMI is associated with perinatal GRM among Global Majority individuals. Intersectional research on weight bias and discrimination, incorporating patient and provider perspectives, is warranted for inclusive, respectful perinatal care.