(756) Perceived Discrimination, Adverse Childhood Experiences, Depression, and Perception of Care in Low Socioeconomic Obstetric Patients

To examine the associations of perceived discrimination, perception of care, Adverse Childhood Experiences (ACE), depression and the impact on obstetrical and neonatal outcomes in a cohort of pregnant patients.

Study Design: This is a prospective observational cohort study of obstetric patients from 2022-2023. At initial prenatal care visit, participants completed baseline questionnaires on ACE; Ethnic Discrimination (PEDQ) analyzed by total score and components of Exclusion/rejection, Stigmatization/devaluation, Threat/aggression, and Discrimination at work; Person-Centered Prenatal Care Scale (PCPC) analyzed by total score and components of Responsive/supportive care, and Communication/autonomy and Dignity/Respect; and Edinburgh Postnatal Depression Scale (EPDS). Obstetrical complications included diabetic and hypertensive disorders and neonatal complications were fetal demise, preterm birth, low birth weight and low Apgar scores.

Results: Of 104 participants; 62% were Hispanic, 23% Black, and 9% White. There was a significant negative correlation between PEDQ, and PCPC (rho= -0.355; p= 0.001). Results showed a positive correlation between PEDQ and ACEs, (r= 0.430; p< 0.001). Black compared to white patients, had lower total mean PCPC scores, (51.4 vs. 71.0, p=0.032), as well as in the domains of responsiveness/support (12.79 vs. 21.17, p=0.047), and dignity/respect (13.21 vs. 18.00, p=0.037). Black compared to Hispanic patients had higher mean scores of discrimination in the domains of stigmatization/devaluation (5.60 vs. 4.57, p= 0.046), and exclusion/rejection (9.60 v. 6.47, p=0.003). Patients with obstetrical complications had lower mean scores in the domain of responsive/supportive (2.361 v 1.423, p=0.037). No differences found in relation to neonatal complications.

Conclusion: Our results suggest that experiences of discrimination negatively affect perceptions of person-centered care. Black pregnant patients experienced more discrimination and had lower baseline person-centered prenatal care scores compared to other races.