Background: In the United States, Black/African American (AA) women face significant health disparities, including higher rates of Adverse Pregnancy Outcomes (APOs). This is despite increased utilization of prenatal care (PNC) over time, which is a critical intervention for identifying and managing pregnancy-related complications. While most research has focused on PNC entry, less attention has been given to the quality of PNC received. This study investigates the association between perceived racial microaggressions during PNC and perceived quality of PNC among AA women.

Methods: Data were drawn from 448 AA women enrolled in the ongoing Life Course Influences on Fetal Environments-2 (LIFE-2) birth cohort in Metropolitan Detroit, Michigan. Racial microaggressions during prenatal care were measured using the Daily Life Experiences–Prenatal Care (DLE-PNC) scale and categorized using the sample median (≥31 vs. <31). Quality of prenatal care (QPNC) was assessed using the Quality of Prenatal Care Questionnaire and dichotomized at the median score (≥122 vs. <122). Binomial regression with an identity link was used to estimate risk differences (RD).

Results: About half of women reported poor QPNC (scores <122). In the unadjusted model, women experiencing more frequent racial microaggressions (DLE-PNC ≥31) had a 19 percentage-point higher probability of poor QPNC compared with those experiencing less frequent microaggressions (RD = 0.19; 95% CI: 0.08–0.30). After adjusting for potential confounders, women experiencing more frequent racial microaggressions had a 12–percentage-point higher probability of poor QPNC (RD = 0.12; 95% CI: 0.01–0.24).

Conclusions: Addressing racial microaggressions in PNC is essential to advancing the quality and equity of care experienced by AA women. Future research should move beyond measures of PNC initiation to incorporate women’s experiences of care quality throughout pregnancy.