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
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Non-Hispanic Black women with chronic hypertension had higher rates of placental abruption.
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Neonates of non-Hispanic Black women with chronic hypertension had higher odds of
PTB, SGA, and LBW.
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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
