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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
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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

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