Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes

Michal Fishel Bartal; Han-Yang Chen; Farah Amro; Hector Mendez-Figueroa; Stephen M. Wagner; Baha M. Sibai; Suneet P. Chauhan

doi:10.1055/a-2000-6289

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e1145-e1155
DOI: 10.1055/a-2000-6289

Original Article

Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes

Authors

Michal Fishel Bartal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

²Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Han-Yang Chen

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Farah Amro

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Hector Mendez-Figueroa

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Stephen M. Wagner

³Department of Obstetrics and Gynecology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
Baha M. Sibai

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Suneet P. Chauhan

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

Abstract

Objective We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend.

Study Design Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score <5 at 5 minutes, assisted ventilation> 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs).

Results Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09–1.11), Hispanic (aRR = 1.04, 95% CI = 1.02–1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05–1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37–1.41), Hispanic (aRR = 1.15, 95% CI = 1.13–1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31–1.37), and American Indian (aRR = 1.12, 95% CI = 1.07–1.17). The racial and ethnic disparity remained unchanged during the study period.

Conclusion We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period.

Key Points

Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased.
Among people with chronic hypertension, there are racial and ethnic disparities in adverse outcomes.
Black, Hispanic, and Asian/Pacific Islander have a higher risk of the adverse neonatal outcomes.

Keywords

race - ethnicity - disparity - hypertension - maternal - neonatal

Full Text

References

References
1 National Center for Health Statistics. . Health, United States, 2019: Figure 22. Hyattsville, MD. 2021. Accessed September 10, 2022 at: https://www.cdc.gov/nchs/hus/contents2019.htm
2 National Center for Health Statistics. . Health, United States, 2019: Table 22. Hyattsville, MD. 2021. Accessed September 10, 2022 at: https://www.cdc.gov/nchs/hus/contents2019.htm
3 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
4 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
5 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
6 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
7 Panaitescu AM, Baschat AA, Akolekar R, Syngelaki A, Nicolaides KH. Association of chronic hypertension with birth of small-for-gestational-age neonate. Ultrasound Obstet Gynecol 2017; 50 (03) 361-366
8 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
9 Minhas AS, Ogunwole SM, Vaught AJ. et al. Racial disparities in cardiovascular complications with pregnancy-induced hypertension in the United States. Hypertension 2021; 78 (02) 480-488
10 Stearns K, Tsaih SW, Palatnik A. Racial and ethnic disparities in maternal and neonatal outcomes among women with chronic hypertension. Am J Perinatol 2022; 39 (10) 1033-1041
11 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
12 Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee Jr N, Rice RJ. Maternal hypertension and associated pregnancy complications among African-American and other women in the United States. Obstet Gynecol 1996; 87 (04) 557-563
13 Shah NS, Harrington KA, Huang X, Cameron NA, Yee LM, Khan SS. Trends in de novo hypertensive disorders of pregnancy among Asian and Hispanic population subgroups in the United States, 2011 to 2019. JAMA Cardiol 2022; 7 (07) 742-746
14 Singh GK, Siahpush M, Liu L, Allender M. Racial/ethnic, nativity, and sociodemographic disparities in maternal hypertension in the United States, 2014-2015. Int J Hypertens 2018; 2018: 7897189
15 Osterman MJ, Martin JA, Mathews TJ, Hamilton BE. Expanded data from the new birth certificate, 2008. Natl Vital Stat Rep 2011; 59 (07) 1-28
16 Martin JA, Wilson EC, Osterman MJ, Saadi EW, Sutton SR, Hamilton BE. Assessing the quality of medical and health data from the 2003 birth certificate revision: results from two states. Natl Vital Stat Rep 2013; 62 (02) 1-19
17 Gregory ECW, Martin JA, Argov EL, Osterman MJK. Assessing the quality of medical and health data from the 2003 birth certificate revision: results from New York City. Natl Vital Stat Rep 2019; 68 (08) 1-20
18 Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstet Gynecol 2014; 124 (01) 16-22
19 Joinpoint Regression Program, Version 4.9.1.0 - April 2022; Statistical Methodology and Applications Branch. Surveillance Research Program. National Cancer Institute
20 Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for Ioinpoint Regression with applications to cancer rates. Stat Med 2000; 19 (03) 335-351
21 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457
22 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
23 Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol 2020; 222 (06) 532-541
24 Smolen JR, Thorpe Jr. RJ, Bowie JV, Gaskin DJ, LaVeist TA. Health insurance and chronic conditions in low-income urban whites. J Urban Health 2014; 91 (04) 637-647
25 Robbins C, Boulet SL, Morgan I. et al. Disparities in preconception health indicators - behavioral risk factor surveillance system, 2013-2015, and pregnancy risk assessment monitoring system, 2013-2014. MMWR Surveill Summ 2018; 67 (01) 1-16
26 Kariisa M, Seiber E. Distribution of cardiovascular disease and associated risk factors by county type and health insurance status: results from the 2008 Ohio Family Health Survey. Public Health Rep 2015; 130 (01) 87-95
27 Yee LM, Silver R, Haas DM. et al. Association of health literacy among nulliparous individuals and maternal and neonatal outcomes. JAMA Netw Open 2021; 4 (09) e2122576
28 Beckie TM. Ethnic and racial disparities in hypertension management among women. Semin Perinatol 2017; 41 (05) 278-286
29 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
30 Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol 2012; 120 (04) 920-927
31 Tita AT, Szychowski JM, Boggess K. et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022; 386 (19) 1781-1792
32 SMFM statement: antihypertensive therapy for mild chronic hypertension in pregnancy: the CHAP trial. . Accessed January 3, 2023 at: https://www.smfm.org/publications/439-smfm-statement-antihypertensive-therapy-for-mild-chronic-hypertension-in-pregnancy-the-chap-trial

Supplementary Material

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