Differences in Maternal Outcomes Among American Indian/Alaska Native and White Women with Hypertensive Disorder of...

Hypertensive disorders of pregnancy (HDP) are associated with substantial maternal morbidity and mortality. The purpose of this study was to describe demographic and clinical factors that differ between American Indian/Alaska Native (AI/AN) and White women with HDP in North Dakota.

We conducted a retrospective descriptive analysis of resident, in-state, singleton births among AI/AN and White women with HDP using 2007-2020 North Dakota birth records from the Division of Vital Records. Descriptive analyses were performed using summary statistics and bivariate comparisons to compare demographic risk factors and maternal outcomes between AI/AN and White women with HDP. Annual trends in HDP diagnoses were also analyzed.

From 2007 to 2020, the prevalence of HDP increased significantly from 4.4% to 12.1%. The prevalence increased significantly among both AI/AN women (6.6% to 13.6%, p < 0.001) and White women (4.1% to 11.9%, p < 0.001). Compared with White women, AI/AN women had higher rates of cesarean delivery (45.3% vs. 38.5%, p < 0.001), cesarean delivery after a trial of labor (30.5% vs. 23.1%, p < 0.001), preterm birth (23.1% vs. 17.0%, p < 0.001), fetal macrosomia (3.2% vs. 1.3%, p < 0.001), and blood transfusion (2.2% vs. 1.2%, p = 0.009). AI/AN women had lower rates of third- or fourth-degree perineal laceration (0.4% vs. 1.6%, p = 0.004) and cephalic presentation at delivery (91.9% vs. 94.9%, p < 0.001).

HDP increased significantly from 2007 to 2020 among both AI/AN and White women in North Dakota. Among pregnancies complicated by HDP, AI/AN women experienced higher rates of several adverse maternal and delivery outcomes. These findings highlight the need for targeted and culturally responsive strategies to improve maternal outcomes among AI/AN women.