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Published on: January 12, 2018
Differential risk of hypertensive disorders of pregnancy among Hispanic women
Myles Wolf1, Anand Shah, Ricardo Jimenez-Kimble
1Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. mswolf@partners.org
Insights
Hispanic women have a higher risk of preeclampsia but a lower risk of gestational hypertension during pregnancy. Early hypertension in pregnancy for Hispanic women may indicate preeclampsia.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Epidemiology
Background:
- Preeclampsia and gestational hypertension are significant pregnancy complications with long-term cardiovascular health implications.
- Existing research indicates disparities in chronic hypertension rates between Hispanic and non-Hispanic Caucasian women.
- Limited studies have specifically compared the incidence of hypertensive disorders of pregnancy between these ethnic groups.
Purpose of the Study:
- To compare the risks of preeclampsia and gestational hypertension in a prospective cohort of normotensive, nulliparous Hispanic and non-Hispanic Caucasian women.
- To identify independent risk factors for preeclampsia and gestational hypertension in these populations.
Main Methods:
- Prospective cohort study involving 863 Hispanic and 2,381 non-Hispanic Caucasian nulliparous women.
- Statistical analysis included relative risk (RR) and hazard ratio (HR) calculations, adjusting for covariates like age, smoking, diabetes, BMI, and multiple gestation.
- Assessment of socioeconomic status and prenatal care access as potential contributing factors.
Main Results:
- Hispanic women showed a significantly decreased incidence of gestational hypertension (1.6% vs. 8.5%; P < 0.01) but a similar incidence of preeclampsia (3.8% vs. 3.7%; P = 0.9) compared to non-Hispanic Caucasian women.
- Adjusted analysis revealed an increased RR for preeclampsia in Hispanic women (RR 1.9; P = 0.01) and a decreased RR for gestational hypertension (RR 0.39; P < 0.01).
- Hispanic women presenting with hypertension during pregnancy were over threefold more likely to develop preeclampsia (HR 3.3; P < 0.01). Baseline BP, BMI, diabetes, and multiple gestation were independent risk factors for preeclampsia; BP and BMI for gestational hypertension. Socioeconomic factors and prenatal care access were not associated with either disorder.
Conclusions:
- Hispanic ethnicity is independently associated with an elevated risk of preeclampsia and a reduced risk of gestational hypertension.
- Hypertension presenting early in pregnancy among Hispanic women is likely indicative of preeclampsia.
- Findings highlight ethnic disparities in hypertensive disorders of pregnancy, necessitating tailored clinical approaches.
Abstract:
Preeclampsia and gestational hypertension are leading complications of pregnancy that also portend increased risk of future chronic hypertension. Although rates of chronic hypertension differ between non-Hispanic Caucasian and Hispanic women, few studies examined their relative rates of hypertensive disorders of pregnancy. The purpose of this study was to compare the risk of preeclampsia and gestational hypertension in a prospective cohort of normotensive, nulliparous Hispanic (n = 863) and non-Hispanic Caucasian women (n = 2,381). Compared with non-Hispanic Caucasian women, Hispanic women demonstrated a significantly decreased incidence of gestational hypertension (1.6% versus 8.5%; P < 0.01), but a similar incidence of preeclampsia (3.8% versus 3.7%; P = 0.9). Adjusting for age, smoking, diabetes, BP, body mass index (BMI), and multiple gestation uncovered an increased relative risk (RR) for preeclampsia among Hispanic women (RR 1.9; 95% CI, 1.1 to 3.3; P = 0.01), while their relative risk for gestational hypertension remained significantly decreased (RR 0.39; 95% CI, 0.22 to 0.72; P < 0.01). Among women who initially presented with hypertension during pregnancy, Hispanic women were over threefold (hazard ratio 3.3; 95% CI, 1.9 to 6.0; P < 0.01) more likely to develop preeclampsia than non-Hispanic Caucasian women. Besides Hispanic ethnicity, baseline BP, BMI, diabetes, and multiple gestation were independent risk factors for preeclampsia, whereas only baseline BP and BMI were associated with gestational hypertension. Socioeconomic status and access to prenatal care were not associated with either disorder. Hispanic ethnicity is independently associated with increased risk for preeclampsia and decreased risk for gestational hypertension. The initial presentation of hypertension during pregnancy in Hispanic women most likely represents early preeclampsia.
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