{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:07:55Z","timestamp":1789150075156,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,8]]},"group-title":"Obstetrics and Gynecology","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Racialized disparities in hypertensive disorders of pregnancy persist, yet the role of interconnected structural determinants has not been fully explored. We evaluated the association between county-level indicators of structural racial discrimination (SRD) and Black-White disparities in HDP in Georgia.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted exploratory factor analysis to identify latent factors of county-level SRD from 12 indicators representing historic racial violence, criminal justice, residential segregation, and political representation. We linked factor scores to 2020-2024 Georgia natality data and estimated associations between factor scores (tertiles) and Black-White differences in HDP rates.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified two latent factors: Historic Racism and Racialized Polarization. HDP occurred in 15.5% of 206,438 Black births and 13.1% of 265,693 White births. Compared with the first tertile of Historic Racism factor scores, scores in the second (T2) and third (T3) tertiles were associated with increased Black-White HDP disparities (T2: 6.3, 95% confidence interval [CI]: \u20133.0-15.5; T3: 5.0, 95% CI: 5.4-15.4). Higher Racialized Polarization scores were associated with increased Black-White HDP disparities (T2: 9.1, 95% CI: \u20130.3-18.5; T3: 9.8, 95% CI: \u20131.5-21.2).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Structural racism contributes to racial disparities in HDP in Georgia, where historic oppression remains embedded in contemporary legal, political, and social systems.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.05.26362353","type":"posted-content","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:15:20Z","timestamp":1788923720000},"source":"Crossref","is-referenced-by-count":0,"title":["County-Level Structural Racism and Racial Disparities in Hypertensive Disorders of Pregnancy in Georgia"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7638-7374","authenticated-orcid":false,"given":"Sheree L","family":"Boulet","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA"},{"name":"Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Abdelghany","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Epidemiology, School of Public Health, Boston University, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kienle","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1540-3059","authenticated-orcid":false,"given":"Kaitlyn K","family":"Stanhope","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Darville","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA"},{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Kramer","sequence":"additional","affiliation":[{"name":"Center for Rural Health & Health Disparities, School of Medicine, Mercer University, Macon, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Psychology, 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