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Am J Perinatol 2022; 39(10): 1033-1041
DOI: 10.1055/a-1745-2902
SMFM Fellowship Series Article

Racial and Ethnic Disparities in Maternal and Neonatal Outcomes among Women with Chronic Hypertension

Kristen Stearns
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Shirng-Wern Tsaih
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Anna Palatnik 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
2   Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations Funding None.
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Abstract

Objective The objective of this study was to compare maternal and neonatal outcomes in women with chronic hypertension by maternal race and ethnicity.

Methods A retrospective cohort study of women with chronic hypertension was performed from the Consortium on Safe Labor (2002–2008). Maternal self-reported race and ethnicity were analyzed as non-Hispanic White, non-Hispanic Black, and Hispanic. Maternal outcomes included cesarean birth, postpartum hemorrhage, blood transfusion, placental abruption, eclampsia, maternal intensive care unit admission, and death. Neonatal outcomes included preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), 5-minute Apgar <7, respiratory distress syndrome, hypoxic-ischemic encephalopathy, intraventricular hemorrhage, neonatal intensive care unit admission, sepsis, and death. Univariable and multivariable analyses were performed to examine the association between maternal race and ethnicity and perinatal outcomes.

Results A total of 2,729 women were included. In unadjusted analysis, non-Hispanic White women had higher rates of placental abruption and Hispanic women had higher rates of placental abruption and eclampsia. In multivariable analysis, non-Hispanic Black continued to have higher odds of placental abruption (adjusted odds ratio 4.16, 95% confidence interval 1.29–18.70), but the rest of the maternal outcomes did not differ between the groups. When comparing neonatal outcomes, PTB, SGA, and LBW were more frequent in, 5-minute Apgar <7 non-Hispanic Black and Hispanic women compared with non-Hispanic White women. In addition, 5-minute Apgar <7 and neonatal sepsis were more frequent in non-Hispanic Black neonates and neonatal death was more frequent in Hispanic neonates compared with non-Hispanic White women. In multivariable regression, neonates of non-Hispanic Black women had higher odds of PTB, SGA, LBW, 5-minute Apgar < 7, and sepsis compared with non-Hispanic White women. Similarly, neonates of Hispanic women had higher odds of SGA, LBW, and death.

Conclusion Significant racial and ethnic disparities were identified mainly in neonatal outcomes of women with chronic hypertension.

Key Points

  • Non-Hispanic Black women with chronic hypertension had higher rates of placental abruption.

  • Neonates of non-Hispanic Black women with chronic hypertension had higher odds of PTB, SGA, and LBW.

  • Neonates of Hispanic women with chronic hypertension had higher odds of SGA, LBW, and neonatal death.

Keywords

chronic hypertension - racial and ethnic disparities - maternal outcomes - neonatal outcomes - placental abruption

Precis

Significant racial and ethnic disparities in adverse obstetric and neonatal outcomes are present among women with chronic hypertension.


Each author has indicated that he/she has met the journal's requirements for authorship.


This study was presented at the 41st Annual Meeting of the Society for Maternal-Fetal Medicine, Virtual Meeting, Jan 2thh to 30th, 2021.




Publication History

Received: 11 February 2021

Accepted: 17 January 2022

Accepted Manuscript online:
19 January 2022

Article published online:
24 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Seely EW, Ecker J. Chronic hypertension in pregnancy. Circulation 2014; 129 (11) 1254-1261
    CrossrefPubMedGoogle Scholar
  • 2 Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012; 206 (02) 134.e1-134.e8
    CrossrefPubMedGoogle Scholar
  • 3 Martin JA, Hamilton BE, Osterman MJ. Births in the United States, 2015. NCHS Data Brief 2016 Sep;(258):1-8. PMID: 27648876
    PubMedGoogle Scholar
  • 4 Ananth CV, Duzyj CM, Yadava S, Schwebel M, Tita ATN, Joseph KS. Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension 2019; 74 (05) 1089-1095
    CrossrefPubMedGoogle Scholar
  • 5 Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol 2020; 222 (06) 532-541
    CrossrefPubMedGoogle Scholar
  • 6 Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100 (02) 369-377
    PubMedGoogle Scholar
  • 7 American College of O, Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
    PubMedGoogle Scholar
  • 8 Ankumah NA, Cantu J, Jauk V. et al. Risk of adverse pregnancy outcomes in women with mild chronic hypertension before 20 weeks of gestation. Obstet Gynecol 2014; 123 (05) 966-972
    CrossrefPubMedGoogle Scholar
  • 9 Panaitescu AM, Syngelaki A, Prodan N, Akolekar R, Nicolaides KH. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2017; 50 (02) 228-235
    CrossrefPubMedGoogle Scholar
  • 10 Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 2014; 348: g2301
    CrossrefPubMedGoogle Scholar
  • 11 Gilbert WM, Young AL, Danielsen B. Pregnancy outcomes in women with chronic hypertension: a population-based study. J Reprod Med 2007; 52 (11) 1046-1051
    PubMedGoogle Scholar
  • 12 Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med 2004; 164 (19) 2126-2134
    CrossrefPubMedGoogle Scholar
  • 13 Ghosh G, Grewal J, Männistö T. et al. Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women. Ethn Dis 2014; 24 (03) 283-289
    Google Scholar
  • 14 Small M, Carr A, Kershaw T, Brown H. OS028. Hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox. Pregnancy Hypertens 2012; 2 (03) 191
    CrossrefPubMedGoogle Scholar
  • 15 Miranda ML, Swamy GK, Edwards S, Maxson P, Gelfand A, James S. Disparities in maternal hypertension and pregnancy outcomes: evidence from North Carolina, 1994-2003. Public Health Rep 2010; 125 (04) 579-587
    CrossrefPubMedGoogle Scholar
  • 16 Premkumar A, Henry DE, Moghadassi M, Nakagawa S, Norton ME. The interaction between maternal race/ethnicity and chronic hypertension on preterm birth. Am J Obstet Gynecol 2016; 215 (06) 787.e1-787.e8
    CrossrefPubMedGoogle Scholar
  • 17 Graham J, Zhang L, Schwalberg R. Association of maternal chronic disease and negative birth outcomes in a non-Hispanic Black-White Mississippi birth cohort. Public Health Nurs 2007; 24 (04) 311-317
    CrossrefPubMedGoogle Scholar
  • 18 Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol 2013; 25 (02) 124-132
    CrossrefPubMedGoogle Scholar
  • 19 Tucker MJ, Berg CJ, Callaghan WM, Hsia J. The Black-White disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. Am J Public Health 2007; 97 (02) 247-251
    CrossrefPubMedGoogle Scholar
  • 20 Zhang J, Troendle J, Reddy UM. et al. Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (04) 326.e1-326.e10
    CrossrefPubMedGoogle Scholar
  • 21 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; Jul; 183 (01) S1-S22
    CrossrefPubMedGoogle Scholar
  • 22 Alexander GR, Kogan M, Martin J, Papiernik E. What are the fetal growth patterns of singletons, twins, and triplets in the United States?. Clin Obstet Gynecol 1998; 41 (01) 114-125
    CrossrefPubMedGoogle Scholar
  • 23 Beckie TM. Ethnic and racial disparities in hypertension management among women. Semin Perinatol 2017; 41 (05) 278-286
    CrossrefPubMedGoogle Scholar
  • 24 Nobles CJ, Mendola P, Mumford SL. et al. Preconception blood pressure and its change into early pregnancy: early risk factors for preeclampsia and gestational hypertension. Hypertension 2020; 76 (03) 922-929
    CrossrefPubMedGoogle Scholar
  • 25 Miller EC, Zambrano Espinoza MD, Huang Y. et al. Maternal race/ethnicity, hypertension, and risk for stroke during delivery admission. J Am Heart Assoc 2020; 9 (03) e014775
    CrossrefPubMedGoogle Scholar
  • 26 Paradies Y, Ben J, Denson N. et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One 2015; 10 (09) e0138511
    CrossrefPubMedGoogle Scholar
  • 27 Webster LM, Gill C, Seed PT. et al. Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers. Am J Physiol Regul Integr Comp Physiol 2018; 315 (01) R36-R47
    CrossrefPubMedGoogle Scholar
  • 28 Brown HL, Fan YD, Gonsoulin WJ. Obstetric complications in young teenagers. South Med J 1991; 84 (01) 46-48 , 64
    CrossrefPubMedGoogle Scholar
  • 29 Leland NL, Petersen DJ, Braddock M, Alexander GR. Variations in pregnancy outcomes by race among 10-14-year-old mothers in the United States. Public Health Rep 1995; 110 (01) 53-58
    PubMedGoogle Scholar
  • 30 Sabol BA, de Sam Lazaro S, Salati J, Allen A, Snowden J, Caughey AB. Racial and ethnic differences in pregnancy outcomes in women with chronic hypertension. Obstet Gynecol 2014; 168S-169S
    CrossrefPubMedGoogle Scholar
  • 31 Samadi AR, Mayberry RM. Maternal hypertension and spontaneous preterm births among Black women. Obstet Gynecol 1998; 91 (06) 899-904
    PubMedGoogle Scholar
  • 32 Baer RJ, Altman MR, Oltman SP. et al. Maternal factors influencing late entry into prenatal care: a stratified analysis by race or ethnicity and insurance status. J Matern Fetal Neonatal Med 2019; 32 (20) 3336-3342
    CrossrefPubMedGoogle Scholar
  • 33 Carr A, Kershaw T, Brown H, Allen T, Small M. Hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox. J Neonatal Perinatal Med 2013; 6 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 34 Brown HL, Chireau MV, Jallah Y, Howard D. The “Hispanic paradox”: an investigation of racial disparity in pregnancy outcomes at a tertiary care medical center. Am J Obstet Gynecol 2007; 197 (02) 197.e1-197.e7 , discussion 197.e7–197.e9
    CrossrefPubMedGoogle Scholar
  • 35 Shahul S, Tung A, Minhaj M. et al. Racial disparities in comorbidities, complications, and maternal and fetal outcomes in women with preeclampsia/eclampsia. Hypertens Pregnancy 2015; 34 (04) 506-515
    CrossrefPubMedGoogle Scholar