Like other women and girls of color in the U.S. education system, Black women and girls negotiate and integrate multiple marginalized identities in mathematics. As such, this integrative review used critical race theory (CRT) and Black feminism as interpretive frames to explore factors that contribute to Black women's and girls' persistence in the mathematics pipeline and the role these factors play in shaping their academic outcomes. A synthesis of 62 research studies reveals that structural disruptions, community influences, and resilience strategies significantly influence Black women's and girls' persistence in mathematics, and that combined, these factors can culminate into a more robust mathematics identity for Black women and girls. A robust mathematics identity, in turn, is an aspect of self-actualization that is needed for persistence, engagement, and sustained success in the pursuit of a mathematics doctoral degree. New questions, paradigms, and ways of examining the experiences of Black women and girls in mathematics to advance further knowledge that will inform policy are identified and discussed as a future research agenda.